Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.
Prince of Wales Hospital and Community Health Services, Sydney, NSW.
Med J Aust. 2024 Sep 16;221(6):310-316. doi: 10.5694/mja2.52420. Epub 2024 Aug 28.
To examine the frequency of re-admissions to non-index hospitals (hospitals other than the initial discharging hospital) within 30 days of admission with acute myocardial infarction in New South Wales; to examine the relationship between non-index hospital re-admissions and 30-day mortality.
Retrospective cohort study; analysis of hospital admissions (Admitted Patient Data Collection) and mortality data (Registry of Births, Deaths and Marriages).
SETTING, PARTICIPANTS: Adults admitted to NSW hospitals with acute myocardial infarction re-admitted to any hospital within 30 days of discharge from the initial hospitalisation, 1 January 2005 - 31 December 2020.
Proportion of re-admissions within 30 days of discharge to non-index hospitals, and associations of non-index hospital re-admissions with demographic and initial hospitalisation characteristics and with 30-day and 12-month mortality, each by residential remoteness category.
Of 168 097 people with acute myocardial infarction discharged alive, 28 309 (16.8%) were re-admitted to hospital within 30 days of discharge, including 11 986 to non-index hospitals (42.3%); the proportion was larger for people from regional or remote areas (50.1%) than for people from major cities (38.3%). The odds of non-index hospital re-admission were higher for people with ST-elevation myocardial infarction, for people whose index admissions were to private hospitals, who were transferred between hospitals or had undergone revascularisation during the initial admission, were under 65 years of age, or had private health insurance; the influence of these factors was generally larger for people from regional or remote areas than for those from large cities. After adjustment for potential confounders, non-index hospital re-admission did not influence mortality among people from major cities (30-day: adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 0.99-1.20; 12-month: aOR, 0.98, 95% CI, 0.93-1.03), but was associated with reduced mortality for people from regional or remote areas (30-day: aOR, 0.81; 95% CI, 0.70-0.95; 12-month: aOR, 0.88; 95% CI, 0.81-0.96).
The geographically dispersed Australian population and the mixed public and private provision of specialist services means that re-admission to a non-index hospital can be unavoidable for people with acute myocardial infarction who are initially transferred to specialised facilities. Non-index hospital re-admission is associated with better mortality outcomes for people from regional or remote areas.
在新南威尔士州，观察急性心肌梗死患者入院 30 天内再次入住非索引医院（除初始出院医院以外的医院）的频率；并探讨非索引医院再次入院与 30 天死亡率之间的关系。
回顾性队列研究；对住院患者（入院患者数据采集）和死亡率数据（出生、死亡和婚姻登记处）进行分析。
地点、参与者：2005 年 1 月 1 日至 2020 年 12 月 31 日，在新南威尔士州医院因急性心肌梗死住院并在初次住院后 30 天内再次入住任何医院的成年人。
出院后 30 天内再次入住非索引医院的比例，以及非索引医院再次入院与人口统计学和初始住院特征以及与 30 天和 12 个月死亡率之间的关联，每个特征均按居住偏远程度进行分类。
在 168097 名存活出院的急性心肌梗死患者中，有 28309 名（16.8%）在出院后 30 天内再次入院，其中 11986 名（42.3%）入住非索引医院；来自区域或偏远地区的患者比例（50.1%）高于来自大城市的患者（38.3%）。ST 段抬高型心肌梗死患者、索引入院在私立医院的患者、在初次入院期间转院或接受血管重建的患者、年龄在 65 岁以下或有私人医疗保险的患者再次入住非索引医院的可能性更高；这些因素的影响对于来自区域或偏远地区的患者来说通常大于来自大城市的患者。在调整潜在混杂因素后，非索引医院再次入院与来自大城市的患者的死亡率无关（30 天：调整后的优势比[aOR]，1.09；95%置信区间[CI]，0.99-1.20；12 个月：aOR，0.98，95%CI，0.93-1.03），但与来自区域或偏远地区患者的死亡率降低相关（30 天：aOR，0.81；95%CI，0.70-0.95；12 个月：aOR，0.88；95%CI，0.81-0.96）。
澳大利亚人口分布广泛，专业服务的公共和私人混合提供，这意味着对于最初被转介至专门设施的急性心肌梗死患者来说，再次入住非索引医院可能是不可避免的。非索引医院再次入院与来自区域或偏远地区的患者的死亡率改善结局相关。
