ARE READMISSIONS AVOIDABLE
ARE READMISSIONS AVOIDABLE
复制标题
DOI：
10.1136/bmj.301.6761.1136
复制
发表时间：
1990-11-17
影响因子：
105.7
通讯作者：
CLARKE, A
中科院分区：
文献类型：
--
作者：
CLARKE, A
目的：通过调查出院后28天内计划外再入院的可避免性，研究再入院率作为医院住院治疗结局指标的可能性。设计图：回顾性分析了1987年7月至1988年6月期间由9名临床评估员（263项评估）进行的计划外再入院患者的病例记录分层随机样本，并将再入院分类为可避免、不可避免或不可分类。设定：东北泰晤士地区（英格兰，英国）; 481名普通内科、老年科和普通外科住院患者，在1987年7月至1988年6月首次（索引）出院后0-6天或21-27天再次入院，随机选择100例病例记录，其中74例可用于研究。主要结局指标：根据专业和再入院持续时间，将再入院评估为可避免、不可避免、不可分类、病例内评估的差异性和评估人员之间的差异性。结果如下：出院后0-6天的一般内科和老年科再入院和手术再入院比21-27天的再入院更有可能被评估为可避免的（内科再入院32 v 6%，手术再入院49 v 19%）。普通外科再入院被评估为可避免的次数明显多于普通内科和老年科再入院。医生之间的协议程度各不相同，一般医疗和老年再入院后21-27天，第一次出院造成最大的变化的判断。结论：在不同的入院组中，再入院的可避免程度存在明显差异。然而，评估者认为只有49.3%的可避免入院比例最高的一组（0-6天的手术再入院）是可避免的。其余的被认为是不可避免的，除了2%，这是无法分类。应避免使用再入院率作为医院住院治疗的结果指标。
Objective: To examine the possible use of readmission rates as an outcome indicator of hospital inpatient care by investigating avoidability of unplanned readmission within 28 days of discharge. Design: Retrospective analysis of a stratified random sample of case notes of patients with an unplanned readmission between July 1987 and June 1988 by nine clinical assessors (263 assessments) and categorisation of the readmission as avoidable, unavoidable, or unclassifiable. Setting: District in North East Thames region (England, UK); 481 General medical, geriatric, and general surgical inpatients with a readmission at 0-6 days or 21-27 days after the first (index) discharge between July 1987 and June 1988 from whom 100 cases notes were selected randomly and of which 74 were available for study. Main outcome measures: Assessment of readmissions as avoidable, unavoidable, unclassifiable, variability of assessment within cases and variability among assessors according to specialty and duration to readmission. Results: General medical and geriatric readmissions and surgical readmissions at 0-6 days after discharge were more likely to be assessed as avoidable than those at 21-27 days (medical readmissions 32 v 6%, surgical admissions 49 v 19%). General surgical readmissions were significantly more frequently assessed as avoidable than general medical and geriatric readmissions. The extent of agreement between doctors varied, with general medical and geriatric readmissions at 21-27 days after first discharge causing the greatest variability of judgment. Conclusions: Differences were apparent in the extent of avoidability of readmissions in different groups of admissions. However, assessors rated only 49.3% of the group with the highest proportion of avoidable admissions (surgical readmissions at 0-6 days) as avoidable. The remainder were thought to be unavoidable except for 2%, which could not be classified. The use of readmission rates as an outcome indicator of hospital inpatient care should be avoided.