Exploring Trajectories of Health Care Utilization Before and After Surgery
Exploring Trajectories of Health Care Utilization Before and After Surgery
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DOI：
10.1016/j.jamcollsurg.2018.10.010
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发表时间：
2019-01-01
影响因子：
5.2
通讯作者：
Hawn, Mary T.
中科院分区：
文献类型：
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作者：
Graham, Laura A.;Wagner, Todd H.;Hawn, Mary T.
背景：外科手术背景下医疗保健利用的长期轨迹尚未得到很好的表征。本研究的目的是检查外科患者的医疗保健利用轨迹，并确定与手术入院后可能减轻的高利用率相关的因素。研究设计：对2007年10月1日至2014年9月30日在退伍军人健康管理局（Veterans Health Administration）进行指数住院手术后2年内的住院和外科入院情况进行分析。基于组的轨迹分析确定了手术前后住院患者的5种不同轨迹。使用双变量统计和多变量逻辑回归比较各组间的利用轨迹特征。结果：280,681例住院患者中，大多数接受了骨科手术（29.2%）、普通手术（28.4%）或周围血管手术（12.2%）。确定了医疗保健利用的五种轨迹，其中5.2%的患者持续高住院用户占住院天数的34.0%。与其他轨迹相比，男性（95.4% vs 93.5%, p < 0.01）、非裔美国人（21.6% vs 17.3%, p < 0.01）或未婚患者（61.6% vs 52.5%, p < 0.01）更有可能成为高医疗保健使用者。重度使用者也有更高的合并症负担和更高的精神健康诊断负担（抑郁症：30.3%对16.3%；双相情感障碍：5.3%对2.1%,p < 0.01），社会/行为风险因素（吸烟者：41.1%对33.6%,p < 0.01；酒精使用障碍：28.9%对12.9%,p < 0.01）和慢性疼痛（6.4%对2.8%,p < 0.01）。结论：心理健康、社会/行为和疼痛相关因素与手术患者术前和术后高卫生保健使用率独立相关。在手术期间将患者与社会工作者和精神卫生保健协调员联系起来可能会降低与这些因素相关的术后再入院风险。(C) 2018年由美国外科医师学会发布。Elsevier Inc.出版。版权所有。)
BACKGROUND: Long-term trajectories of health care utilization in the context of surgery have not been well characterized. The objective of this study was to examine health care utilization trajectories among surgical patients and identify factors associated with high utilization that could possibly be mitigated after surgical admissions.STUDY DESIGN: Hospital medical and surgical admissions within 2 years of an index inpatient surgery in the Veterans Health Administration (October 1, 2007 to September 30, 2014) were identified. Group-based trajectory analysis identified 5 distinct trajectories of inpatient admissions around surgery. Characteristics of trajectories of utilization were compared across groups using bivariate statistics and multivariate logistic regression.RESULTS: Of 280,681 surgery inpatients, most underwent orthopaedic (29.2%), general (28.4%), or peripheral vascular procedures (12.2%). Five trajectories of health care utilization were identified, with 5.2% of patients among consistently high inpatient users accounting for 34.0% of inpatient days. Male (95.4% vs 93.5%, p < 0.01), African-American (21.6% vs 17.3%, p < 0.01), or unmarried patients (61.6% vs 52.5%, p < 0.01) were more likely to be high health care users as compared with other trajectories. High users also had a higher comorbidity burden and a strikingly higher burden of mental health diagnoses (depression: 30.3% vs 16.3%; bipolar disorder: 5.3% vs 2.1%, p < 0.01), social/behavioral risk factors (smoker: 41.1% vs 33.6%, p < 0.01; alcohol use disorder: 28.9% vs 12.9%, p < 0.01), and chronic pain (6.4% vs 2.8%, p < 0.01).CONCLUSIONS: Mental health, social/behavioral, and pain-related factors are independently associated with high pre-and postoperative health care utilization in surgical patients. Connecting patients to social workers and mental health care coordinators around the time of surgery may mitigate the risk of postoperative readmissions related to these factors. ((C) 2018 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)