Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078.
Institute of Clinical Pharmacology, Central South University, Changsha 410078.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 May 28;47(5):619-627. doi: 10.11817/j.issn.1672-7347.2022.210356.
Stroke readmission increases financial burden on the family and the consumption of medical resources, and 30-day readmission rate is an important indicator for quality evaluation on health services. The influential factors for readmission mainly include patient-related factors, hospital factors, and society-related factors, with regional differences. This study aims to explore the spatial distribution and its main relevant factors for 30-day readmission of stroke patients in Hunan Province, and to provide the useful information for the improvement of regional prevention and control of stroke readmission.
Stroke patients in Hunan Province who were hospitalized in 2018 and readmitted within 30 days were included in the study. The vector map of the county boundary in Hunan Province was used as the basic map since county was the spatial analysis unit. SPSS 26.0 and ArcGIS 10.8 were used for statistical analysis that contains descriptive analysis of the general situation and the distribution map of readmission rate within 30 days of stroke patients. Spatial autocorrelation analysis and spatial regression analysis were further used to find the spatial clusters of the 30-day readmission rate of stroke and the local relationship between the readmission rate and main influential factors.
In 2018, a total of 172 800 stroke patients were hospitalized in Hunan Province, of which 6 953 patients were re-hospitalized within 30 days after discharging due to stroke. The 30-day readmission rate was 4.09% in Hunan Province. The clusters of stroke readmission rates were mainly concentrated in the northeast and western regions in Hunan Province. The geographically weighted regression revealed that proportion of patients with complications, number of hospitals per 10 000 population and number of primary medical and health care institution per 10 000 population were the main relevant factors for stroke readmission, and there were differences both in the direction and degree of the effect on readmission in different regions.
The 30-day readmission rate for stroke patients in Hunan province and its main influential factors had spatial heterogeneity. The key prevention and control areas were mainly concentrated in the northeast and western regions. It is recommended that the prevention and treatment of stroke complications and the construction of medical institutions need to be strengthened to improve the quality of medical services, particularly in the western region. The importance to the treatment of stroke complications should be attached in the northern region, and the primary health care should be reinforced in the northeast region. All counties should take prevention and control measures according to local conditions, so as to effectively control the readmission rate of stroke within 30 days.
卒中再入院增加了家庭经济负担和医疗资源消耗，30 天再入院率是评价医疗服务质量的重要指标。影响再入院的因素主要包括患者相关因素、医院相关因素和社会相关因素，具有区域性差异。本研究旨在探讨湖南省卒中患者 30 天再入院的空间分布及其主要相关因素，为提高区域卒中再入院防控水平提供有益信息。
纳入 2018 年在湖南省住院且 30 天内再次入院的卒中患者，以湖南省县界矢量地图作为基本地图，以县为空间分析单元。采用 SPSS 26.0 和 ArcGIS 10.8 进行统计分析，包括卒中患者一般情况及 30 天内再入院率的分布地图描述性分析。进一步采用空间自相关分析和空间回归分析，发现卒中患者 30 天再入院率的空间聚集和再入院率与主要影响因素的局部关系。
2018 年湖南省共收治卒中患者 172800 例，出院后 30 天内因卒中再次入院 6953 例，再入院率为 4.09%。卒中再入院率的聚集区主要集中在湖南省东北部和西部地区。地理加权回归显示，并发症比例、每万人拥有的医院数和每万人拥有的基层医疗卫生机构数是卒中再入院的主要相关因素，且在不同地区对再入院的影响方向和程度存在差异。
湖南省卒中患者 30 天再入院率及其主要影响因素存在空间异质性，关键防控区域主要集中在东北部和西部地区。建议加强卒中并发症防治和医疗机构建设，提高医疗服务质量，特别是西部地区。北部地区应重视卒中并发症的治疗，东北地区应加强基层卫生保健。各区县应根据当地情况采取防控措施，有效控制 30 天内卒中再入院率。
