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基于患者人口统计学、物质使用和保险情况评估 COVID-19 大流行对 30 天再入院率的影响。

Assessing the influence of COVID-19 pandemic on thirty days readmission rate based on patient's demographics, substance use, and insurance.

机构信息

Internal Medicine Department, Overlake Medical Center, Bellevue, WA, USA.

Internal Medicine Department, Loma Linda University, Loma Linda, CA, USA.

出版信息

Ann Med. 2024 Dec;56(1):2399752. doi: 10.1080/07853890.2024.2399752. Epub 2024 Nov 4.

Abstract

Providing the highest quality care with no biases is the goal of every healthcare system. As a part of that goal hospital readmission has been investigated due to its impact on healthcare cost and case fatality rate in patient outcome. Patient's demographics, substance use and insurance barriers have been investigated as factors for readmission rate but the impact of COVID-19 pandemic on those biases and barriers have not been studied extensively yet. In our retrospective cross-sectional study, we placed the scope on readmission rate with the intention to investigate any relation with patient's demographics including ethnicity, gender, language, substance use and insurance barriers and if there has been any change in the area pre and post COVID-19 pandemic. Total of 1713 readmitted patients were identified and split into 893 pre-COVID-19 and 820 post COVID-19 pandemic. Our multivariable analysis showed that the rate of readmissions during the COVID-19 pandemic was statistically higher among substance users ( = 0.003) and Medicaid insured ( = 0.038), and less likely among Spanish speakers  = 0.003. This study is limited due to small sample size and does not accurately represent the full population of the United States. Our hope is to further investigate the impact of COVID-19 pandemic on the readmission rate and to identify any influencing factors, biases, and barriers that contributed to the increased rate of readmission to learn and avoid future readmissions during straining times in medicine such as during COVID-19 pandemic.

摘要

为每一个医疗体系提供高质量、无偏见的医疗服务是其目标。由于医院再入院率会影响医疗成本和患者预后的病死率,因此它也成为了该目标的一部分。患者的人口统计学特征、物质使用和保险障碍已被视为再入院率的影响因素,但 COVID-19 大流行对这些偏见和障碍的影响尚未得到广泛研究。在我们的回顾性横断面研究中,我们将研究范围放在再入院率上,旨在调查患者人口统计学特征(包括种族、性别、语言、物质使用和保险障碍)与再入院率之间的任何关系,以及在 COVID-19 大流行前后该地区是否发生了任何变化。共确定了 1713 例再入院患者,分为 COVID-19 前 893 例和 COVID-19 后 820 例。我们的多变量分析显示,COVID-19 大流行期间物质使用者( = 0.003)和医疗补助保险者( = 0.038)的再入院率统计学上更高,而西班牙语使用者( = 0.003)的再入院率则更低。这项研究由于样本量小而受到限制,无法准确代表美国的全部人群。我们希望进一步研究 COVID-19 大流行对再入院率的影响,并确定任何导致再入院率增加的影响因素、偏见和障碍,以便在医学紧张时期(如 COVID-19 大流行期间)吸取经验教训并避免未来再入院。

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Racial Disparities in 7-Day Readmissions from an Adult Hospital Medicine Service.成人医院内科服务的 7 天再入院的种族差异。
J Racial Ethn Health Disparities. 2022 Aug;9(4):1500-1505. doi: 10.1007/s40615-021-01088-3. Epub 2021 Jun 28.

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