Association of dementia with early rehospitalization among Medicare beneficiaries
Association of dementia with early rehospitalization among Medicare beneficiaries
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DOI：
10.1016/j.archger.2014.02.010
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发表时间：
2014-07-01
影响因子：
4
通讯作者：
Gravenstein, Stefan
中科院分区：
文献类型：
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作者：
Daiello, Lori A.;Gardner, Rebekah;Gravenstein, Stefan
可接受的再入院被认为是医院质量的指标，增加医疗保健支出的来源，以及患者，家庭和护理人员的负担。尽管针对与潜在可避免的再入院相关的风险因素的举措有所增加，但痴呆症对再住院可能性的影响特征不佳。因此，这项回顾性队列研究的主要目的是调查痴呆是否是30天再入院的独立预测因素。2009年所有罗得岛医院入院的行政索赔数据被用来确定诊断为阿尔茨海默病或其他痴呆症的医疗保险按服务收费受益人的住院情况。从数据中提取人口统计学、共病疾病负担指标和其他潜在混杂因素，并通过条件logistic回归模型计算30天内再次入住任何美国医院的几率。从25，839例住院病例中，有3908例符合痴呆症诊断研究标准的医疗保险受益人指数入院。近20%的入院患者（n = 5133）在30天内再次入院。与非痴呆患者住院治疗相比，痴呆诊断受益人住院治疗后30天内再次入院的可能性更大（调整后比值比（AOR）1.18; 95%CI，1.08，1.29）。控制出院护理部位并没有削弱这种关联（AOR 1.21; 95%CI，1.10，1.33）。(C)由Elsevier爱尔兰Ltd.出版
Preventable hospital readmissions have been recognized as indicators of hospital quality, a source of increased healthcare expenditures, and a burden for patients, families, and caregivers. Despite growth of initiatives targeting risk factors associated with potentially avoidable hospital readmissions, the impact of dementia on the likelihood of rehospitalization is poorly characterized. Therefore, the primary objective of this retrospective cohort study was to investigate whether dementia was an independent predictor of 30-day readmissions. Administrative claims data for all admissions to Rhode Island hospitals in 2009 was utilized to identify hospitalizations of Medicare fee-for-service beneficiaries with a diagnosis of Alzheimer's Disease or other dementias. Demographics, measures of comorbid disease burden, and other potential confounders were extracted from the data and the odds of 30-day readmission to any United States hospital was calculated from conditional logistic regression models. From a sample of 25,839 hospitalizations, there were 3908 index admissions of Medicare beneficiaries who fulfilled the study criteria for a dementia diagnosis. Nearly 20% of admissions (n = 5133) were followed by a readmission within thirty days. Hospitalizations of beneficiaries with a dementia diagnosis were more likely to be followed by a readmission within thirty days (adjusted odds ratio (AOR) 1.18; 95% CI, 1.08, 1.29), compared to hospitalizations of those of without dementia. Controlling for discharge site of care did not attenuate the association (AOR 1.21; 95% CI, 1.10, 1.33). (C) 2014 Published by Elsevier Ireland Ltd.