Avoidable hospitalizations in patients with systemic lupus erythematosus
Avoidable hospitalizations in patients with systemic lupus erythematosus
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DOI：
10.1002/art.23346
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发表时间：
2008-02-15
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影响因子：
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通讯作者：
Ward, Michael M.
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作者：
Ward, Michael M.
适当的门诊治疗。因此，避免住院是医疗服务难以获得或利用不足的一个指标。本研究旨在探讨系统性红斑狼疮（SLE）患者可避免住院的危险因素。收集了2000年、2001年和2002年在纽约州住院的8,670例年龄≥ 18岁的SLE患者的急性护理住院数据。根据住院的主要适应症，住院被归类为可避免的。将患者人口统计学和医院特征作为危险因素进行检查。在16，751例住院治疗中，2，123例（12.7%）是由于可避免的疾病，最常见的是肺炎，充血性心力衰竭和蜂窝织炎。可避免住院的可能性随着年龄的增长而逐渐增加，参加医疗保险的患者比参加其他类型医疗保险的患者更高，而社会经济地位较低的患者更高。与SLE患者较少的医院相比，SLE患者较多的医院因可避免的疾病住院的可能性较小。避免住院在老年和贫困患者中更常见，这表明这些患者更难以获得护理。在收治大量SLE患者的中心，可避免的住院风险较低，这可能是由于患者的选择，也可能是这些中心医生更好的门诊治疗。
appropriate outpatient treatment. Avoidable hospitalizations thus serve as an indicator of poor access to, or underutilization of, medical care. This study examined risk factors for avoidable hospitalizations among patients with systemic lupus erythematosus (SLE).Methods. Data were obtained on acute-care hospitalizations in a population-based sample of 8,670 patients with SLE age >= 18 years hospitalized in New York state in 2000, 2001, and 2002. Hospitalizations were classified as avoidable based on the principal indication for hospitalization. Patient demographic and hospital characteristics were examined as risk factors.Results. Of 16,751 hospitalizations, 2,123 (12.7%) were for avoidable conditions, most commonly pneumonia, congestive heart failure, and cellulitis. The likelihood of avoidable hospitalizations increased progressively with age, was higher among patients with Medicare than among those with other types of medical insurance, and was higher among those of lower socioeconomic status. Hospitalizations for avoidable conditions were less likely at hospitals that admitted larger numbers of patients with SLE than at hospitals that admitted fewer patients with SLE.Conclusion. Avoidable hospitalizations occur more commonly among older and poorer patients, suggesting that these patients have more difficulty accessing care. The lower risk of avoidable hospitalizations at centers that admit large numbers of patients with SLE may be due to patient selection or may represent better outpatient care by physicians at these centers.