Relationship Between Early Physician Follow-up and 30-Day Readmission Among Medicare Beneficiaries Hospitalized for Heart Failure
Relationship Between Early Physician Follow-up and 30-Day Readmission Among Medicare Beneficiaries Hospitalized for Heart Failure
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DOI：
10.1001/jama.2010.533
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发表时间：
2010-05-05
影响因子：
120.7
通讯作者：
Curtis, Lesley H.
中科院分区：
文献类型：
--
作者：
Hernandez, Adrian F.;Greiner, Melissa A.;Curtis, Lesley H.
因心力衰竭住院后再入院的情况很常见。住院后的早期门诊随访被认为是降低再住院率的一种手段。目的探讨心力衰竭患者出院后7天内门诊随访与30天内再入院之间的关系。从2003年1月1日至12月31日，对65岁或65岁以上心力衰竭患者出院后出院的患者进行设计、设置和患者观察分析，并与指南--心力衰竭质量改善计划相一致。主要指标：出院后30天内全因再入院。结果研究对象包括225家医院的30136名患者。中位住院时间为4天(四分位数范围为2-6天)，21.3%的患者在30天内再次入院。在医院层面，出院后有早期随访的患者从指数住院的中位数百分比为38.3%(四分位数范围为32.4%-44.5%)。与早期随访指数处于最低四分位数的患者相比(30天再住院率，23.3%)，第二四分位数的患者30天再住院率为20.5%(风险调整后的风险比[HR]为0.85；95%可信区间[CI]为0.78-0.93)，第三四分位数的患者30天再住院率为20.5%(风险调整后的HR为0.87；结论心力衰竭住院患者出院后早期门诊随访率存在较大差异。从早期随访率较高的医院出院的患者再次住院30天的风险较低。
Context Readmission after hospitalization for heart failure is common. Early outpatient follow-up after hospitalization has been proposed as a means of reducing readmission rates. However, there are limited data describing patterns of follow-up after heart failure hospitalization and its association with readmission rates.Objective To examine associations between outpatient follow-up within 7 days after discharge from a heart failure hospitalization and readmission within 30 days.Design, Setting, and Patients Observational analysis of patients 65 years or older with heart failure and discharged to home from hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure and the Get With the Guidelines-Heart Failure quality improvement program from January 1, 2003, through December 31, 2006.Main Outcome Measure All-cause readmission within 30 days after discharge.Results The study population included 30 136 patients from 225 hospitals. Median length of stay was 4 days (interquartile range, 2-6) and 21.3% of patients were readmitted within 30 days. At the hospital level, the median percentage of patients who had early follow-up after discharge from the index hospitalization was 38.3% (interquartile range, 32.4%-44.5%). Compared with patients whose index admission was in a hospital in the lowest quartile of early follow-up (30-day readmission rate, 23.3%), the rates of 30-day readmission were 20.5% among patients in the second quartile (riskadjusted hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.78-0.93), 20.5% among patients in the third quartile (risk-adjusted HR, 0.87; 95% CI, 0.78-0.96), and 20.9% among patients in the fourth quartile (risk-adjusted HR, 0.91; 95% CI, 0.83-1.00).Conclusions Among patients who are hospitalized for heart failure, substantial variation exists in hospital-level rates of early outpatient follow-up after discharge. Patients who are discharged from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission.