Changes in hospitalization patterns among patients with congenital heart disease during the transition from adolescence to adulthood
Changes in hospitalization patterns among patients with congenital heart disease during the transition from adolescence to adulthood
复制标题
DOI：
10.1016/j.jacc.2006.09.051
复制
发表时间：
2007-02-27
影响因子：
24
通讯作者：
Chang, Ruey-Kang
中科院分区：
文献类型：
--
作者：
Gurvitz, Michelle Z.;Inkelas, Moira;Chang, Ruey-Kang
目标.本研究旨在评估先天性心脏病（CHD）患者从青少年到成年的过渡期的住院模式。关于青少年和成人CHID患者住院的人群数据很少。从2000年至2003年加州出院数据库中选择12至44岁的CHID患者。描述了患者人口统计学资料、住院模式、急诊（艾德）入院情况、CHID复杂性和保险模式。数据以3岁为增量进行分析，并在21岁以上和21岁以下的患者之间进行比较。通过多元回归分析确定经艾德入院的预测因素。有9 017人在368家医院住院。对于12至20岁的患者，12家医院占住院病例的70%;对于21至44岁的患者，25家医院仅占44.8%。在保险方面，53%的入学是私人的，44%是公共的，< 4%是自费的。65%的患者患有复杂的CHID，19%的患者在住院期间接受了心脏手术。通过艾德入院的患者比例在向成年过渡的过程中几乎翻了一番。通过艾德入院的积极预测因素包括公共保险、自费和年龄> 17岁，而接受手术和女性则降低了这种可能性。先天性心脏病住院发生在各种各样的医院，并随着患者进入成年而分散。这些发现需要进一步调查，以检查获得护理和可能的差异，因为它们对未来的医疗保健规划很重要。
Objectives. This study was designed to evaluate hospitalization patterns of congenital heart disease (CHD) patients surrounding the transition from adolescence to adulthood.Background. Few population data exist on hospitalizations among adolescent and adult CHID patients.Methods. Patients ages 12 to 44 years with CHID were selected from the 2000 to 2003 California hospital discharge database. Patient demographics, hospitalization patterns, emergency department (ED) admissions, CHID complexity, and insurance patterns were described. Data were analyzed in 3-year age increments and compared between patients over and under age 21. Predictors of admission via the ED were determined using multivariate regression analysis.Results. There were 9,017 hospitalizations at 368 hospitals. For patients ages 12 to 20 years, 12 hospitals accounted for 70% of hospitalizations; for patients ages 21 to 44 years, 25 hospitals accounted for only 44.8% of cases. Regarding insurance, 53% of admissions were private, 44% public, and < 4% were self-pay. Sixty-five percent of patients had complex CHID and 19% had a cardiac procedure during hospitalization. The proportion of patients admitted via the ED nearly doubled surrounding the transition to adulthood. The positive predictors of admission via the ED included public insurance, self-pay, and age > 17 years, whereas having a procedure and being female decreased the likelihood.Conclusions. Congenital heart disease hospitalizations occur at a wide variety of hospitals and disperse as patients enter adulthood. Those without private insurance and > 17 years old are at higher risk of being admitted via the ED. These findings require further investigation to examine access to care and possible disparities, as they are important for future healthcare planning.