Filippi Matteo, Del Prete Erika, Aquilini Ferruccio, Totaro Michele, Di Serafino Francesca, Civitelli Sara, Geminale Giulia, Rocchi David, Zotti Nunzio, Baggiani Angelo
The Azienda Ospedaliero Universitaria Pisana (AOUP), 56100 Pisa, Italy.
Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56123 Pisa, Italy.
Healthcare (Basel). 2023 Feb 23;11(5):651. doi: 10.3390/healthcare11050651.
Readmissions are hospitalizations following a previous hospitalization (called index hospitalization) of the same patient that occurred in the same facility or nursing home. They may be a consequence of the progression of the natural history of a disease, but they may also reveal a previous suboptimal stay, or ineffective management of the underlying clinical condition. Preventing avoidable readmissions has the potential to improve both a patient's quality of life, by avoiding exposure to the risks of re-hospitalization, and the financial well-being of health care systems.
We investigated the magnitude of 30 day repeat hospitalizations for the same Major Diagnostic Category (MDC) in the Azienda Ospedaliero Universitaria Pisana (AOUP) over the period from 2018 to 2021. Records were divided into only admissions, index admissions and repeated admission. The length of the stay of all groups was compared using analysis of variance and subsequent multi-comparison tests.
Results showed a reduction in readmissions over the period examined (from 5.36% in 2018 to 4.46% in 2021), likely due to reduced access to care during the COVID-19 pandemic. We also observed that readmissions predominantly affect the male sex, older age groups, and patients with medical Diagnosis Related Groups (DRGs). The length of stay of readmissions was longer than that of index hospitalization (difference of 1.57 days, 95% CI 1.36-1.78 days, < 0.001). The length of stay of index hospitalization is longer than that of single hospitalization (difference of 0.62 days, 95% CI 0.52-0.72 days, < 0.001).
A patient who goes for readmission thus has an overall hospitalization duration of almost two and a half times the length of the stay of a patient with single hospitalization, considering both index hospitalization and readmission. This represents a heavy use of hospital resources, about 10,200 more inpatient days than single hospitalizations, corresponding to a 30-bed ward working with an occupancy rate of 95%. Knowledge of readmissions is an important piece of information in health planning and a useful tool for monitoring the quality of models of patient care.
再入院是指同一患者在同一医疗机构或养老院进行先前住院治疗（称为索引住院）后再次住院。它们可能是疾病自然史进展的结果，但也可能揭示先前住院期间护理欠佳或基础临床状况管理无效。预防可避免的再入院有可能通过避免再次住院的风险来提高患者的生活质量，并改善医疗保健系统的财务状况。
我们调查了2018年至2021年期间比萨大学医院（AOUP）同一主要诊断类别（MDC）的30天重复住院情况。记录仅分为入院、索引入院和再次入院。使用方差分析和后续多重比较检验比较所有组的住院时间。
结果显示，在所研究的期间内再入院率有所下降（从2018年的5.36%降至2021年的4.46%），这可能是由于在新冠疫情期间获得医疗服务的机会减少所致。我们还观察到，再入院主要影响男性、老年人群以及患有医疗诊断相关组（DRG）的患者。再入院的住院时间比索引住院长（相差1.57天，95%可信区间为1.36 - 1.78天，P < 0.001）。索引住院的住院时间比单次住院长（相差0.62天，95%可信区间为0.52 - 0.72天，P < 0.001）。
因此，考虑到索引住院和再入院，进行再入院的患者的总体住院时长几乎是单次住院患者住院时长的两倍半。这意味着大量使用医院资源，比单次住院多约10200个住院日，相当于一个30张床位的病房以95%的占用率运转。了解再入院情况是卫生规划中的一项重要信息，也是监测患者护理模式质量的有用工具。
