Department of Biomedical Informatics, University of California San Diego, La Jolla, CA.
School of Medicine, University of California San Diego, La Jolla, CA.
Crit Care Explor. 2024 May 24;6(6):e1099. doi: 10.1097/CCE.0000000000001099. eCollection 2024 Jun 1.
To determine the predictive value of social determinants of health (SDoH) variables on 30-day readmission following a sepsis hospitalization as compared with traditional clinical variables.
Multicenter retrospective cohort study using patient-level data, including demographic, clinical, and survey data.
Thirty-five hospitals across the United States from 2017 to 2021.
Two hundred seventy-one thousand four hundred twenty-eight individuals in the AllofUs initiative, of which 8909 had an index sepsis hospitalization.
None.
Unplanned 30-day readmission to the hospital. Multinomial logistic regression models were constructed to account for survival in determination of variables associate with 30-day readmission and are presented as adjusted odds rations (aORs). Of the 8909 sepsis patients in our cohort, 21% had an unplanned hospital readmission within 30 days. Median age (interquartile range) was 54 years (41-65 yr), 4762 (53.4%) were female, and there were self-reported 1612 (18.09%) Black, 2271 (25.49%) Hispanic, and 4642 (52.1%) White individuals. In multinomial logistic regression models accounting for survival, we identified that change to nonphysician provider type due to economic reasons (aOR, 2.55 [2.35-2.74]), delay of receiving medical care due to lack of transportation (aOR, 1.68 [1.62-1.74]), and inability to afford flow-up care (aOR, 1.59 [1.52-1.66]) were strongly and independently associated with a 30-day readmission when adjusting for survival. Patients who lived in a ZIP code with a high percentage of patients in poverty and without health insurance were also more likely to be readmitted within 30 days (aOR, 1.26 [1.22-1.29] and aOR, 1.28 [1.26-1.29], respectively). Finally, we found that having a primary care provider and health insurance were associated with low odds of an unplanned 30-day readmission.
In this multicenter retrospective cohort, several SDoH variables were strongly associated with unplanned 30-day readmission. Models predicting readmission following sepsis hospitalization may benefit from the addition of SDoH factors to traditional clinical variables.
与传统临床变量相比，确定健康社会决定因素（SDoH）变量对脓毒症住院后 30 天再入院的预测价值。
使用患者水平数据的多中心回顾性队列研究，包括人口统计学、临床和调查数据。
2017 年至 2021 年期间美国的 35 家医院。
AllofUs 计划中的 271428 人，其中 8909 人有指数脓毒症住院。
无。
无计划的 30 天内再次住院。构建多项逻辑回归模型以说明生存情况，以确定与 30 天再入院相关的变量，并以调整后的优势比（aOR）表示。在我们的队列中，8909 例脓毒症患者中有 21%在 30 天内发生无计划的医院再入院。中位年龄（四分位间距）为 54 岁（41-65 岁），4762 例（53.4%）为女性，有 1612 例（18.09%）自我报告为黑人，2271 例（25.49%）为西班牙裔，4642 例（52.1%）为白人。在考虑生存的多项逻辑回归模型中，我们发现由于经济原因转为非医师提供者类型（aOR，2.55 [2.35-2.74]）、由于缺乏交通而延迟接受医疗护理（aOR，1.68 [1.62-1.74]）以及无力承担随访护理（aOR，1.59 [1.52-1.66]）在调整生存后与 30 天内再入院强烈且独立相关。居住在贫困患者和没有医疗保险的患者比例较高的邮政编码的患者也更有可能在 30 天内再次入院（aOR，1.26 [1.22-1.29]和 aOR，1.28 [1.26-1.29]）。最后，我们发现有初级保健提供者和医疗保险与较低的无计划 30 天内再入院几率相关。
在这项多中心回顾性队列研究中，几个 SDoH 变量与无计划的 30 天再入院强烈相关。预测脓毒症住院后再入院的模型可能受益于在传统临床变量中添加 SDoH 因素。
