Boult C, Dowd B, McCaffrey D, Boult L, Hernandez R, Krulewitch H
Department of Family Practice and Community Health, University of Minnesota Medical School, Minneapolis.
J Am Geriatr Soc. 1993 Aug;41(8):811-7. doi: 10.1111/j.1532-5415.1993.tb06175.x.
To define a set of screening criteria that identifies elders who are at high risk for repeated hospital admission in the future.
Longitudinal cohort study. Logistic regression analysis of data from half of the subjects was used to identify risk factors for repeated hospital admission. The ability of these risk factors to identify elders who are at high risk for repeated hospitalization in the future was then tested using data from the other half of the subjects.
United States.
A subsample (n = 5876) of a multistage probability sample of all non-institutionalized U.S. civilians who were 70 years or older in 1984.
At baseline (1984), elderly subjects were asked about their demographic, socioeconomic, medical, and functional characteristics and about their recent use of health services. Their subsequent hospital admissions and mortality were then monitored through the records of the Medicare program and the National Death Index (1985-88).
Among the subjects in the first half of the sample, eight factors emerged as risk factors for repeated admission: older age, male sex, poor self-rated general health, availability of an informal caregiver, having ever had coronary artery disease, and having had, during the previous year, a hospital admission, more than six doctor visits, or diabetes. Based on the presence or absence of these factors in 1984, 7.2% of the subjects in the second half of the sample were estimated to have a high probability of repeated admission (Pra > or = 0.5) during 1985-1988. In comparison with subjects estimated to have a low risk (Pra < 0.5), this high-risk group's actual experiences during 1985-1988 included a higher cumulative incidence of repeated admission (41.8% vs 26.2%, P < 0.0001), a higher cumulative rate of mortality (44.2% vs 19.0%, P < 0.0001), more hospital days per person-year survived (5.2 vs 2.6), and higher hospital charges per person-year survived ($3731 vs $1841).
Eight easily ascertained risk factors affect elders' probability of being hospitalized repeatedly within four years. In the future, brief surveys about the presence of these factors could be used to estimate elders' risk of future hospitalization and, thereby, to identify some of those who may derive the greatest benefit from interventions designed to avert the need for hospitalization.
确定一套筛查标准，以识别未来有再次入院高风险的老年人。
纵向队列研究。对一半受试者的数据进行逻辑回归分析，以确定再次入院的风险因素。然后使用另一半受试者的数据来测试这些风险因素识别未来有再次住院高风险老年人的能力。
美国。
1984年年龄在70岁及以上的所有非机构化美国平民多阶段概率样本的一个子样本（n = 5876）。
在基线（1984年）时，询问老年受试者的人口统计学、社会经济、医疗和功能特征以及他们最近使用医疗服务的情况。随后通过医疗保险计划记录和国家死亡指数（1985 - 1988年）监测他们的住院情况和死亡率。
在样本前半部分的受试者中，有八个因素成为再次入院的风险因素：年龄较大、男性、自我评定的总体健康状况较差、有非正式照顾者、曾患冠状动脉疾病，以及在前一年有过住院、看医生超过六次或患有糖尿病。根据1984年这些因素的有无情况，估计样本后半部分7.2%的受试者在1985 - 1988年期间有再次入院的高概率（Pra≥0.5）。与估计为低风险（Pra < 0.5）的受试者相比，这个高风险组在1985 - 1988年期间的实际情况包括再次入院的累积发生率更高（41.8%对vs 26.2%，P < 0.0001）、累积死亡率更高（44.2%对vs 19.0%，P < 0.0001）、每人年存活天数的住院天数更多（5.2对vs 2.6）以及每人年存活天数的住院费用更高（3731美元对vs 1841美元）。
八个易于确定的风险因素影响老年人在四年内再次住院的概率。未来，关于这些因素存在情况的简短调查可用于估计老年人未来住院的风险，从而识别出一些可能从旨在避免住院需求的干预措施中获益最大的人。
