From the Research Center for Emergency Medicine.
Department of Clinical Pharmacology, Aarhus, Denmark.
J Patient Saf. 2022 Jun 1;18(4):e714-e721. doi: 10.1097/PTS.0000000000000939. Epub 2021 Dec 17.
The primary aim of this study was to evaluate whether a high Medication Risk Score (MERIS) upon admission to an emergency department is associated with increased risk of 30-day readmission in patients discharged directly home. Mortality, visit to general practitioner, and drug changes within 30 days were included as secondary outcomes.
This is a historical cohort study with data from the Danish population-based open-cohort CROSS-TRACKS. Cox regression analyses were used to determine whether a high MERIS score was associated with increased risk of 30-day readmission and mortality. Visit to general practitioner and drug changes were tested with χ2 test and Wilcoxon rank sum test.
A total of 2106 patients were eligible: 2017 had a MERIS score lower than 14 (low-risk group), and 89 had a score of 14 or higher (high-risk group). The proportion of patients in the high-risk group who were readmitted was 21.3% compared with 16.3% in the low-risk group, resulting in a hazard ratio for readmission of 1.43 (95% confidence interval, 0.9-1.3). The hazard ratio for mortality was 8.3 (95% confidence interval, 3.0-22.8). No statistical significant difference was found in general practitioner visits; however, significantly more drug changes were observed in the high-risk group.
A high MERIS score was associated with increased risk of readmissions and can potentially assist healthcare professionals in the prioritizing of patients who may benefit from further exam, for example, additional medication review in acute care setting. Further investigation of MERIS and exploration of causal inferences between medication-related harm and medication-related readmissions are warranted.
本研究的主要目的是评估急诊入院时高药物风险评分（MERIS）是否与直接出院回家的患者 30 天内再入院风险增加相关。死亡率、全科医生就诊和 30 天内药物变化被纳入次要结局。
这是一项基于丹麦人群的开放队列 CROSS-TRACKS 的历史队列研究。使用 Cox 回归分析确定高 MERIS 评分是否与 30 天内再入院和死亡率增加相关。使用卡方检验和 Wilcoxon 秩和检验检验全科医生就诊和药物变化。
共有 2106 名患者符合条件：2017 年 MERIS 评分低于 14 分（低危组）的患者有 2017 名，评分 14 分或更高（高危组）的患者有 89 名。高危组再入院患者比例为 21.3%，而低危组为 16.3%，再入院风险比为 1.43（95%置信区间，0.9-1.3）。死亡率的风险比为 8.3（95%置信区间，3.0-22.8）。全科医生就诊无统计学显著差异；然而，高危组观察到的药物变化明显更多。
高 MERIS 评分与再入院风险增加相关，可能有助于医疗保健专业人员优先考虑可能受益于进一步检查的患者，例如在急性护理环境中进一步药物审查。需要进一步研究 MERIS，并探讨药物相关危害与药物相关再入院之间的因果关系。
