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急性缺血性脑卒中后 30 天再入院的预测因素、时间、原因和费用:来自中国队列 2015-2018 年的见解。

Predictors, timing, causes and cost of 30-day readmission after acute ischemic stroke: insights from a Chinese cohort 2015-2018.

机构信息

Department of Industrial Engineering and Management, Business School, Sichuan University, Chengdu, Sichuan, China.

School of Finance and Business, Chengdu Vocational & Technical College of Industry, Chengdu, Sichuan, China.

出版信息

Neurol Res. 2022 Nov;44(11):1011-1023. doi: 10.1080/01616412.2022.2105489. Epub 2022 Jul 24.

Abstract

BACKGROUND

This study aims to empirically investigated the risk factors, timing, and cost of the 30-day readmission after ischemic stroke.

METHODS

We used the administrative claims data with 18,983 in-patients of ischemic stroke from 2015 to 2018 of a supercity in western China. The test was used in univariate analysis. A multivariate cox model and a multivariate linear regression method were used to identify those predictors of the 30-day readmission and the cumulative cost, respectively.

RESULTS

The overall 30-day readmission rate was 18.8%, of which 36.4% and 60.9% were readmitted within 7 and 14 days, respectively. Nearly 50% were readmitted for recurrent ischemic stroke. Male, rural areas, aged under 50, resident's insurance scheme, primary hospitals, LOS under 1 week or over two weeks, and comorbidities including congestive heart failure, solid tumor, fluid and electrolyte disorders, and depression were independent predictors of 30-day readmission. We also found that the 30-day readmission was associated with an 76% increase in the cumulative hospitalization cost (P < 0.001) after multivariate adjustment analysis.

CONCLUSIONS

The findings highlight the importance of the readmission of ischemic stroke and corresponding policies and interventions, and our work could provide a potential manage path for the reduction of readmission rate.

摘要

背景

本研究旨在对缺血性脑卒中 30 天再入院的风险因素、时间和费用进行实证研究。

方法

我们使用了来自中国西部一个超大城市 2015 年至 2018 年的 18983 名缺血性脑卒中住院患者的行政索赔数据。使用检验进行单变量分析。使用多变量 cox 模型和多变量线性回归方法分别识别 30 天再入院和累积费用的预测因素。

结果

总体 30 天再入院率为 18.8%,其中 36.4%和 60.9%分别在 7 天和 14 天内再入院。近 50%的再入院是由于复发性缺血性脑卒中。男性、农村地区、50 岁以下、居民保险计划、基层医院、住院时间少于 1 周或超过 2 周以及共病,包括充血性心力衰竭、实体瘤、液体和电解质紊乱以及抑郁症是 30 天再入院的独立预测因素。我们还发现,经过多变量调整分析,30 天再入院与累积住院费用增加 76%相关(P<0.001)。

结论

研究结果强调了缺血性脑卒中再入院的重要性和相应的政策和干预措施,我们的工作可以为降低再入院率提供潜在的管理途径。

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