Wu Vincent, Quinonez Sean, Myers My, Borodunovich Kyle, Shamsi Aisha, Stocker Patrick, Fink Bryan, Ferreira Steven
HCA Healthcare/USF Morsani College of Medicine GME Programs, St. Petersburg, FL.
HCA Florida St. Petersburg Hospital, St. Petersburg, FL.
HCA Healthc J Med. 2023 Feb 28;4(1):35-42. doi: 10.36518/2689-0216.1415. eCollection 2023.
Decreased readmission rates are largely seen as an indicator of effective care and improved resource management. The case management team at St. Petersburg General Hospital in St. Petersburg, Florida identified chronic obstructive pulmonary disease (COPD) exacerbation, pneumonia, and sepsis as 3 of the leading diagnoses on index admission that later led to 30-day readmissions. By examining patients with these 3 diagnoses on index admission, we decided to investigate potential readmission risk factors including patient age, sex, race, body mass index (BMI), length of stay during the index admission, insurance type during index admission, discharge placement after index admission, coronary artery disease, heart failure, and type 2 diabetes.
We conducted a retrospective study with data from 4180 patients at St. Petersburg General Hospital from 2016 through 2019 with index admission diagnoses of COPD exacerbation, pneumonia, and sepsis. A univariate analysis was conducted on patient sex, race, BMI, length of stay during the index admission, health insurance type during the index admission, discharge placement after the index admission, presence of coronary artery disease, presence of heart failure, and presence of type 2 diabetes. Subsequently, a bivariate analysis was run on these variables in relation to 30-day readmissions. Then a multivariable analysis was completed using binary logistic regression and pairwise analysis to determine the significance between variables within the categories of discharge disposition and insurance type.
Of the 4180 patients included in this study, 926 (22.2%) were readmitted within 30 days of discharge. In the bivariate analysis race, BMI, mean length of stay during the index admission, coronary artery disease, heart failure, and type 2 diabetes were not significantly associated with readmission. The bivariate analysis revealed that patients discharged to skilled nursing facilities had the highest readmission rates (28%), followed by home care (26%) ( = .001). Medicaid patients (24%) and Medicare patients (23%) demonstrated higher read-mission rates than those with private insurance (17%) ( = .001). Readmitted patients were slightly younger (62.14 vs. 63.69 years; = .02) in the bivariate analysis. However, in the multi-variable analysis, only patients with type 2 diabetes and patients with non-private insurance were associated with increased readmission rates. Pairwise analysis of the variables within insurance and discharge disposition categories demonstrates decreased readmission for individuals with Private/Other when compared to other insurance subtypes and decreased readmission for Other when compared to discharge disposition subtypes.
Our data demonstrate that hospital readmissions are associated with a diagnosis of type 2 diabetes and having a non-private insurance status. Our findings lead us to suggest further investigation into changes in hospital policies and procedures for these groups that will aim to decrease readmission rates in the future.
再入院率降低在很大程度上被视为有效护理和改善资源管理的一个指标。佛罗里达州圣彼得斯堡市圣彼得斯堡综合医院的病例管理团队确定慢性阻塞性肺疾病（COPD）急性加重、肺炎和败血症是首次入院时的三大主要诊断，这些诊断后来导致了30天再入院情况。通过检查首次入院时患有这三种诊断的患者，我们决定调查潜在的再入院风险因素，包括患者年龄、性别、种族、体重指数（BMI）、首次入院期间的住院时间、首次入院期间的保险类型、首次入院后的出院安置、冠状动脉疾病、心力衰竭和2型糖尿病。
我们对圣彼得斯堡综合医院2016年至2019年的4180例患者的数据进行了回顾性研究，这些患者的首次入院诊断为COPD急性加重、肺炎和败血症。对患者的性别、种族、BMI、首次入院期间的住院时间、首次入院期间的医疗保险类型、首次入院后的出院安置、冠状动脉疾病的存在、心力衰竭的存在以及2型糖尿病的存在进行了单变量分析。随后，对这些变量与30天再入院情况进行了双变量分析。然后使用二元逻辑回归和成对分析完成多变量分析，以确定出院处置和保险类型类别内变量之间的显著性。
本研究纳入的4180例患者中，926例（22.2%）在出院后30天内再次入院。在双变量分析中，种族、BMI、首次入院期间的平均住院时间、冠状动脉疾病、心力衰竭和2型糖尿病与再入院无显著关联。双变量分析显示，出院到专业护理机构的患者再入院率最高（28%），其次是家庭护理（26%）（P = 0.001）。医疗补助患者（24%）和医疗保险患者（23%）的再入院率高于私人保险患者（17%）（P = 0.001）。在双变量分析中，再入院患者年龄稍小（62.14岁对63.69岁；P = 0.02）。然而，在多变量分析中，只有2型糖尿病患者和非私人保险患者的再入院率增加。对保险和出院处置类别内的变量进行成对分析表明，与其他保险亚型相比，拥有私人/其他保险的个体再入院率降低，与出院处置亚型相比，其他出院处置的个体再入院率降低。
我们的数据表明，医院再入院与2型糖尿病诊断和非私人保险状态有关。我们的研究结果促使我们建议对这些群体的医院政策和程序变化进行进一步调查，旨在未来降低再入院率。
