Camberg L C, Smith N E, Beaudet M, Daley J, Cagan M, Thibault G
Health Services Research and Development, Brockton/West Roxbury VA Medical Center, MA 02132, USA.
Med Care. 1997 Aug;35(8):756-67. doi: 10.1097/00005650-199708000-00002.
Is discharge destination a determinant of readmission? Studies to date have been inconclusive. The primary purpose of this study was to identify the role of discharge destination in the occurrence of repeat hospitalizations for a national sample of patients discharged from Veterans Health Administration (VHA) hospitals.
The authors studied a 20% random sample of individual patients, 65 years of age or older, with either chronic obstructive pulmonary disease, stroke, or dementia who were discharged from a Veterans Health Administration hospital in 1988. All data for the study were obtained from secondary administrative sources. Multiple sources were used to determine discharge destination. The authors focused on personal home versus nursing home discharge destination. Both VHA and Medicare discharge data were used to track hospital readmissions. Proportional hazards regression models were used to examine the independent association of discharge destination with time to readmission within 30 days, 6 months, 1 year, and 2 years of discharge, adjusting for severity, other clinical and demographic characteristics, and censoring deaths.
After adjustment and including out-of-system (Medicare) use, we found that patients with chronic obstructive pulmonary disease and patients with dementia who were discharged to nursing homes (community and Veterans Health Administration, respectively) were less likely to be readmitted within 30 days after discharge than patients discharged to personal homes.
These findings have important implications for adjusting hospital performance profiles based on discharge destination and for focussing efforts to reduce the frequency and associated costs of hospital readmissions.
出院目的地是再入院的决定因素吗？迄今为止的研究尚无定论。本研究的主要目的是确定出院目的地在退伍军人健康管理局（VHA）医院出院的全国患者样本再次住院情况中所起的作用。
作者研究了1988年从退伍军人健康管理局医院出院的65岁及以上患有慢性阻塞性肺疾病、中风或痴呆症的个体患者的20%随机样本。研究的所有数据均来自二级行政来源。使用多个来源确定出院目的地。作者重点关注个人家庭与疗养院出院目的地。VHA和医疗保险的出院数据均用于跟踪医院再入院情况。使用比例风险回归模型来检验出院目的地与出院后30天、6个月、1年和2年内再入院时间的独立关联，并对严重程度、其他临床和人口统计学特征以及死亡截尾情况进行调整。
经过调整并纳入系统外（医疗保险）使用情况后，我们发现患有慢性阻塞性肺疾病的患者以及痴呆症患者（分别出院至社区疗养院和退伍军人健康管理局疗养院）出院后30天内再次入院的可能性低于出院至个人家庭的患者。
这些发现对于根据出院目的地调整医院绩效概况以及集中精力降低医院再入院频率和相关成本具有重要意义。
