Care Discontinuity in Emergency General Surgery: Does Hospital Quality Matter?
Care Discontinuity in Emergency General Surgery: Does Hospital Quality Matter?
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DOI：
10.1016/j.jamcollsurg.2020.02.025
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发表时间：
2020-06-01
影响因子：
5.2
通讯作者：
Cooper, Zara
中科院分区：
文献类型：
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作者：
Havens, Joaquim M.;Castillo-Angeles, Manuel;Cooper, Zara
背景：急诊普外科手术(EGS)后护理提供者和医院的变化(护理中断)与发病率和死亡率的增加有关。这些更糟糕的结果的原因尚不清楚。我们的目标是确定医院质量是否与再次入院后的死亡率相关，而不是与护理的连续性无关。STUDY设计：这是对2007年至2015年医疗保险住院患者索赔的回顾分析。所有65岁以上的住院患者接受了7次EGS手术中的1次，显示他们占全国EGS总量、并发症和死亡率的80%。护理中断被定义为在30天内再次入院到非指数医院。医院质量由医院水平、EGS程序风险调整死亡率决定，分为高质量(HQ)和低质量(LQ)。主要结果是总死亡率。结果：共有882,929名EGS患者，其中87,232人在出院后30天内再次入院。护理中断与死亡率独立相关(优势比[OR]1.23；95%可信区间1.17比1.29)。当再入院患者按指标质量和再入院质量分层时，死亡率与指标医院和再入院医院的质量有关。低质量医院指数入院和再入院的患者死亡率最高。结论：在EGS患者中，护理中断和医院质量与死亡率独立相关。这些数据支持维持护理的连续性，即使在表现不佳的医院也是如此。(C)2020年由美国外科医师学会主办。爱思唯尔公司出版，版权所有。
BACKGROUND: Changes in care providers and hospitals after emergency general surgery (EGS) (care discontinuity) are associated with increased morbidity and mortality. The cause of these worse outcomes is unknown. Our goal was to determine if hospital quality is associated with mortality after readmissions independent of continuity in care.STUDY DESIGN: This was a retrospective analysis of Medicare inpatient claims (2007 to 2015). All inpatients older than 65 years of age who underwent 1 of 7 EGS procedures shown to represent 80% of EGS volume, complications, and mortality nationally, were included. Care discontinuity was defined as readmission within 30 days to a nonindex hospital. Hospital quality was determined by hospital-level, risk-adjusted mortality rates by EGS procedure and categorized into high quality (HQ) and low quality (LQ). The primary outcome was overall mortality. Multivariate logistic regression analysis was used to determine the association of discontinuity and mortality.RESULTS: There were 882,929 EGS patients, 87,232 of whom were readmitted within 30 days of discharge. Care discontinuity was independently associated with mortality (odds ratio [OR] 1.23; 95% CI 1.17 to 1.29). When readmitted patients were stratified by quality of index and readmitting hospital, mortality was associated with the quality of both the index hospital and the readmitting hospital. The highest mortality rate was observed in patients with index admission at low-quality hospitals and readmission to a different low-quality hospital.CONCLUSIONS: Both care discontinuity and hospital quality are independently associated with mortality in EGS patients. These data support maintaining continuity of care, even at low performing hospitals. (C) 2020 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.