Readmission after hospitalization for congestive heart failure among Medicare beneficiaries.
Readmission after hospitalization for congestive heart failure among Medicare beneficiaries.
复制标题
医疗保险受益人因充血性心力衰竭住院后再次入院。
DOI：
10.1001/archinte.1997.00440220103013
复制
发表时间：
1997
影响因子：
--
通讯作者：
J. Hennen
中科院分区：
文献类型：
--
作者：
H. Krumholz;Eugene M. Parent;Nora Tu;V. Vaccarino;Yun Wang;M. Radford;J. Hennen
背景
充血性心力衰竭是医疗保险受益人最常见的出院诊断。虽然一些单中心研究表明，这些患者特别容易再入院，但据我们所知，最近没有研究报告了不同医院中大量充血性心力衰竭老年患者的再入院率。
目标
明确老年充血性心力衰竭患者出院后的再入院率。确定导致充血性心力衰竭患者再入院的诊断谱。识别与较高再入院可能性相关的患者和医院特征。
方法
这项观察性研究，使用医疗保险管理文件，评估了从1991财政年度到1994财政年度在康涅狄格州因充血性心力衰竭住院的所有幸存者的再入院和死亡情况。
结果
在研究期间，有17448名因充血性心力衰竭住院的幸存者。在指数入院后的6个月内，7596例患者（44%）至少再次入院一次。充血性心力衰竭是研究患者中最常见的再入院原因，占所有再入院的18%。在多变量分析中，再入院的重要预测因素包括男性（比值比[OR]，1.12; 95%置信区间[CI]，1.05-1.20），指标入院后6个月内至少有1次既往入院（OR，1.64; 95% CI，1.53-1.77），Deyo合并症评分大于1（OR，1.56; 95%CI，1.45-1.68），以及索引住院时间超过7天（OR，1.32; 95%CI，1.24-1.41）。虽然年龄不是再入院的显著预测因素，但在以再入院或死亡的综合结局作为因变量的模型中，年龄变得显著。
结论
充血性心力衰竭住院后再入院在医疗保险受益人中很常见，几乎一半的患者在6个月内再次入院。在一个共同的诊断中，这种惊人的再入院率要求努力进一步澄清再入院的决定因素，并制定策略，以防止这种不良后果。
BACKGROUND
Congestive heart failure is the most common discharge diagnosis for Medicare beneficiaries. While several single-center studies have suggested that these patients are particularly vulnerable to readmission, no recent study, to our knowledge, has reported the readmission rates for a large number of elderly patients with congestive heart failure across a diverse spectrum of hospitals.
OBJECTIVES
To define the readmission rate for elderly patients discharged after an episode of congestive heart failure. To determine the spectrum of diagnoses that are responsible for readmissions among patients with congestive heart failure. To identify patient and hospital characteristics associated with a higher likelihood of readmission.
METHODS
This observational study, using Medicare administrative files, evaluated readmission and death among all survivors of a hospitalization in Connecticut for congestive heart failure from fiscal year 1991 through fiscal year 1994.
RESULTS
There were 17448 survivors of a hospitalization for congestive heart failure during the study period. In the 6 months following the index admission, 7596 patients (44%) were readmitted to a hospital at least once. Congestive heart failure was the most frequent reason for readmission among study patients, accounting for 18% of all readmissions. In the multivariable analysis, significant predictors of readmission included male sex (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.05-1.20), at least 1 prior admission within 6 months of the index admission (OR, 1.64; 95% CI, 1.53-1.77), Deyo comorbidity score of more than 1 (OR, 1.56; 95% CI, 1.45-1.68), and length of stay in the index hospitalization of more than 7 days (OR, 1.32; 95% CI, 1.24-1.41). While age was not a significant predictor of readmission, it became significant in a model with the combined outcome of readmission or death as the dependent variable.
CONCLUSION
Readmission after a hospitalization for congestive heart failure is common among Medicare beneficiaries, with almost half of the patients readmitted within 6 months. This striking rate of readmission in a common diagnosis demands efforts to further clarify the determinants of readmission and develop strategies to prevent this adverse outcome.
影响因子：
158.5
作者：
RICH, MW;BECKHAM, V;CARNEY, RM
通讯作者：
CARNEY, RM