Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events
Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events
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DOI：
10.1007/s11606-017-4095-x
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发表时间：
2017-10-01
影响因子：
5.7
通讯作者：
Shah, Nilay D.
中科院分区：
文献类型：
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作者：
McCoy, Rozalina G.;Lipska, Kasia J.;Shah, Nilay D.
背景：糖尿病患者再入院是很常见的。一些再入院，特别是低血糖和高血糖，可能是可以避免的更好的护理过渡和出院后management.Objective：以确定最常见的原因和危险因素再入院的成人糖尿病患者，特别是考虑到严重的精神障碍。设计：对OptumLabs数据仓库的数据进行回顾性分析，全美商业保险和Medicare Advantage受益人的管理数据集参与者：2009年1月1日至2014年12月31日期间出院的≥ 18岁糖尿病成人（N = 342，186）。主要指标：30天计划外再入院的主要诊断和风险因素，严重精神障碍与所有其他原因的子集。关键结果：我们分析了594，146例成人糖尿病患者的指数住院：平均年龄68.2岁（SD，13.0），52.9%为女性，67.8%为白色。全因30天再入院率为10.8%。心力衰竭是首次住院（5.5%）和再入院（8.9%）的最常见原因。重度精神障碍占指标住院的2.6%（48.1%高血糖，50.4%低血糖，1.5%未指明）和2.5%的再入院（38.3%高血糖，61.0%低血糖，0.7%未指明）。与其他再入院相比，患者年龄较小、指数或既往住院时重度代谢异常和糖尿病并发症严重程度指数（DCSI）是导致患者重度代谢异常的最强风险因素。先前发作的严重精神障碍和DCSI也是其他原因再入院的独立危险因素，无论是什么原因的索引injuries.CONCLUSIONS：成人糖尿病住院和再入院的健康状况范围广泛，和严重的低血糖和高血糖的住院治疗仍然很常见，复发率高。严重的糖尿病性精神障碍最有可能发生在有多种糖尿病并发症和此类事件既往史的年轻患者中。
BACKGROUND: Hospital readmission is common among patients with diabetes. Some readmissions, particularly for hypoglycemia and hyperglycemia, may be avoidable with better care transitions and post-discharge management.OBJECTIVE: To ascertain the most common reasons and risk factors for readmission among adults with diabetes, with specific consideration of severe dysglycemia.DESIGN: Retrospective analysis of data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the U.S.PARTICIPANTS: Adults >= 18 years of age with diabetes, discharged from a hospital between January 1, 2009, and December 31, 2014 (N = 342,186).MAIN MEASURES: Principal diagnoses and risk factors for 30-day unplanned readmissions, subset as being for severe dysglycemia vs. all other causes.KEY RESULTS: We analyzed 594,146 index hospitalizations among adults with diabetes: mean age 68.2 years (SD, 13.0), 52.9% female, and 67.8% white. The all-cause 30-day readmission rate was 10.8%. Heart failure was the most common cause for index hospitalization (5.5%) and readmission (8.9%). Severe dysglycemia accounted for 2.6% of index hospitalizations (48.1% hyperglycemia, 50.4% hypoglycemia, 1.5% unspecified) and 2.5% of readmissions (38.3% hyperglycemia, 61.0% hypoglycemia, 0.7% unspecified). Younger patient age, severe dysglycemia at index or prior hospitalization, and the Diabetes Complications Severity Index (DCSI) were the strongest risk factors predisposing patients to severe dysglycemia vs. other readmissions. Prior episodes of severe dysglycemia and the DCSI were also independent risk factors for other-cause readmissions, irrespective of the cause of the index hospitalization.CONCLUSIONS: Adults with diabetes are hospitalized and readmitted for a wide range of health conditions, and hospitalizations for severe hypoglycemia and hyperglycemia remain common, with high rates of recurrence. Severe dysglycemia is most likely to occur among younger patients with multiple diabetes complications and prior history of such events.