Department of Medicine, University of the Philippines- Philippine General Hospital, Manila, Philippines.
University of the Philippines-College of Medicine, University of the Philippines Manila, Manila, Philippines.
BMC Health Serv Res. 2023 Jun 12;23(1):617. doi: 10.1186/s12913-023-09608-z.
Identifying factors that increase the risk for hospital readmission helps in determining potential targets for quality improvement efforts. The main objective of this study was to examine factors that predict increased risk of hospital readmission within 30 days of hospital discharge of patients under the General Medicine service of a tertiary government hospital in Manila, Philippines.
We performed a retrospective cohort study which included service patients 19 years old and above readmitted within 30 days following discharge. A total of 324 hospital readmissions within 30 days of discharge from January 1 to December 31, 2019 were reviewed. We estimated the rate of 30-day readmission and identified factors associated with preventable readmissions using multivariable logistic regression.
Of the 4,010 hospitalizations under General Medicine service in 2019, 602 (18%) were readmissions within 30 days of discharge, majority of which were related to the index admission (90%) and unplanned (68%). Predictors of preventable readmission were emergency readmission (OR 3.37, 95% CI 1.72 to 6.60), having five to ten medications at discharge (OR 1.78, 95% CI 1.10 to 2.87), and presence of nosocomial infection (OR 1.86, 95% CI 1.09 to 3.17). The most frequent reason for readmission among preventable ones is health-care related infection (42.9%).
We identified factors which increased the likelihood of preventable readmissions such as type of readmission, number of medications per day, and presence of nosocomial infections. We propose that these issues be addressed to improve healthcare delivery and reduce readmission-related expenditures. Further studies should be pursued to identify impactful evidence-based practices.
确定增加医院再入院风险的因素有助于确定质量改进工作的潜在目标。本研究的主要目的是研究菲律宾马尼拉一家三级政府医院综合医学科患者出院后 30 天内再入院风险增加的相关因素。
我们进行了一项回顾性队列研究，纳入了出院后 30 天内再入院的服务患者，年龄在 19 岁及以上。共回顾了 2019 年 1 月 1 日至 12 月 31 日期间出院后 30 天内的 324 例医院再入院。我们使用多变量逻辑回归来估计 30 天内再入院率，并确定与可预防再入院相关的因素。
2019 年综合医学科共有 4010 例住院患者，出院后 30 天内再入院 602 例（18%），其中大部分与指数入院（90%）和非计划性（68%）相关。可预防再入院的预测因素为急诊再入院（OR 3.37，95%CI 1.72 至 6.60）、出院时服用五至十种药物（OR 1.78，95%CI 1.10 至 2.87）和院内感染（OR 1.86，95%CI 1.09 至 3.17）。可预防再入院中最常见的再入院原因是与医疗保健相关的感染（42.9%）。
我们确定了增加可预防再入院可能性的因素，如再入院类型、每日用药数量和院内感染的存在。我们建议解决这些问题以改善医疗服务的提供并减少与再入院相关的支出。应进一步开展研究以确定有影响力的循证实践。
