合并症是多发性硬化症退伍军人全因急诊利用的预测因子。

Comorbidities as predictors of all-cause emergency department utilization among veterans with multiple sclerosis.

机构信息

Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, USA; Psychology Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Department of Neurology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT 06473 USA; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT 06473 USA.

Multiple Sclerosis Center of Excellence West, Veterans Affairs, 1660 South Columbian Way, Seattle, WA, 98108, USA; Rehabilitation Care Service, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA; Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.

出版信息

Mult Scler Relat Disord. 2022 Jun;62:103806. doi: 10.1016/j.msard.2022.103806. Epub 2022 Apr 15.

DOI:10.1016/j.msard.2022.103806

PMID:35452963

Abstract

BACKGROUND

While comorbidities have been associated with all-cause hospitalizations among persons with multiple sclerosis (MS), there has been no examination of their role in all-cause emergency department (ED) utilization. As such, this study aimed to determine if the presence of comorbidities increases the odds of ED usage in a national sample of Veterans with MS.

METHODS

Data were extracted retrospectively from the Veterans Affairs (VA) MS Center of Excellence Data Repository, an electronic health record-based dataset. Veterans who had at least one outpatient visit in 2013, were alive in 2015, and were initially prescribed a disease modifying therapy were included in the dataset (n = 3,742). Current Procedural Terminology codes were used to determine if participants had at least one ED visit during a 24-month time frame beginning 1/1/2013. Comorbidities were identified using ICD-9 codes present before 2013. Separate logistic regressions were conducted for the overall number of comorbidities and categorized comorbidities, adjusting for age, race, and sex.

RESULTS

Nearly 32% (n = 1,191) had at least one ED visit, with those Veterans having an average of 6.67 (SD=3.32) comorbidities. After adjusting for demographics, the number of comorbidities was a significant predictor of ED usage (aOR=1.20; 95% CI: 1.17, 1.23, p<.001). Several comorbidities emerged as independent contributors.

CONCLUSIONS

All-cause ED utilization is prevalent in MS, with usage increasing in the presence of other chronic conditions. These findings underscore the need to view long-term MS care through the lens of chronic disease management.

摘要

背景

尽管合并症与多发性硬化症（MS）患者的全因住院有关，但尚未研究其在全因急诊就诊中的作用。因此，本研究旨在确定在全国范围内患有 MS 的退伍军人样本中，是否存在合并症会增加急诊就诊的几率。

方法

数据从退伍军人事务部（VA）多发性硬化症卓越中心数据资源库中回顾性提取，这是一个基于电子健康记录的数据集。该数据集纳入了至少在 2013 年有一次门诊就诊、2015 年仍存活且最初被开处疾病修正疗法的退伍军人（n=3742）。使用当前程序术语代码确定参与者在 2013 年 1 月 1 日开始的 24 个月内是否至少有一次急诊就诊。使用 ICD-9 代码在 2013 年之前确定合并症。针对整体合并症数量和分类合并症分别进行了逻辑回归，调整了年龄、种族和性别因素。