Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia.
Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia.
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DOI：
10.1001/jama.2012.216476
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发表时间：
2013-01-23
影响因子：
120.7
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Dharmarajan, Kumar;Hsieh, Angela F.;Lin, Zhenqiu;Bueno, Hector;Ross, Joseph S.;Horwitz, Leora I.;Barreto-Filho, Jose Augusto;Kim, Nancy;Bernheim, Susannah M.;Suter, Lisa G.;Drye, Elizabeth E.;Krumholz, Harlan M.
为了更好地指导旨在降低心力衰竭、急性心肌梗死或肺炎住院后30天再入院率的策略，需要进一步了解再入院诊断、再入院时间以及两者与患者年龄、性别和种族的关系。研究因心力衰竭、急性心肌梗死或肺炎住院后30天内再入院的Medicare受益人的再入院诊断和时间。我们分析了2007年至2009年医疗保险按服务收费索赔数据，以确定患者人口统计学特征和心力衰竭、急性心肌梗死或肺炎住院后时间的30天再入院模式。使用医疗保险和医疗补助服务中心的条件类别的汇总版本对再入院诊断进行分类。再入院时间由出院后的天数确定。我们检查了（1）出院后每天（0-30）发生的30天再入院的百分比;（2）累积时间段内最常见的再入院诊断（第0-3、0-7、0-15和0-30天）和连续时间段（0-3、4-7、8-15和16-30天）;（3）常见再入院诊断的再入院中位时间;和（4）患者人口统计学特征与再入院诊断和时间之间的关系。从2007年到2009年，我们确定了1，330，157例心力衰竭住院治疗后30天内的329，308例再入院（24.8%再次入院），548，834例急性心肌梗死住院治疗后30天再次入院108，992例（19.9%再入院），以及1，168，624例肺炎住院后214，239例30天再入院（18.3%再入院）。因相同疾病再次入院的患者比例在指数心力衰竭住院后为35.2%，指数急性心肌梗死住院后为10.0%，指数肺炎住院后为22.4%。在30天内的所有再入院中，分别有61.0%、67.6%和62.6%发生在因心力衰竭、急性心肌梗死或肺炎住院后15天出院。在出院后的累积（0-3、0-7、0-15和0-30天）和连续（0-3、4-7、8-15和16-30天）时间段内，再入院诊断的多样性在很大程度上相似。对于最初因心力衰竭、急性心肌梗死或肺炎住院的患者，至30天再入院的中位时间分别为12天、10天和12天，并且在常见的再入院诊断中具有可比性。无论是再入院诊断，也没有时间实质上不同的年龄，性别，或种族。在因心力衰竭、急性心肌梗死或肺炎住院的医疗保险按服务收费受益人中，住院后一个月内30天再入院的情况很常见，并且无论年龄、性别、种族或出院后的时间如何，再入院诊断的范围相似。
To better guide strategies intended to reduce high rates of 30-day readmission after hospitalization for heart failure, acute myocardial infarction, or pneumonia, further information is needed about readmission diagnoses, readmission timing, and the relationship of both to patient age, sex, and race. To examine readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after hospitalization for heart failure, acute myocardial infarction, or pneumonia. We analyzed 2007 to 2009 Medicare Fee-For-Service claims data to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare & Medicaid Services’ Condition Categories. Readmission timing was determined by day after discharge. We examined (1) the percentage of 30-day readmissions occurring on each day (0–30) after discharge; (2) the most common readmission diagnoses occurring during cumulative time periods (days 0–3, 0–7, 0–15, and 0–30) and consecutive time periods (days 0–3, 4–7, 8–15, and 16–30) after hospitalization; (3) median time to readmission for common readmission diagnoses; and (4) the relationship between patient demographic characteristics and readmission diagnoses and timing. From 2007 to 2009, we identified 329,308 30-day readmissions after 1,330,157 heart failure hospitalizations (24.8% readmitted), 108,992 30-day readmissions after 548,834 acute myocardial infarction hospitalizations (19.9% readmitted), and 214,239 30-day readmissions after 1,168,624 pneumonia hospitalizations (18.3% readmitted). The proportion of patients readmitted for the same condition was 35.2% after index heart failure hospitalization, 10.0% after index acute myocardial infarction hospitalization, and 22.4% after index pneumonia hospitalization. Of all readmissions within 30 days, 61.0%, 67.6%, and 62.6% occurred with 15 days of discharge after hospitalization for heart failure, acute myocardial infarction, or pneumonia, respectively. The diverse spectrum of readmission diagnoses was largely similar in both cumulative (days 0–3, 0–7, 0–15, and 0–30) and consecutive (days 0–3, 4–7, 8–15, and 16–30) time periods after discharge. Median time to 30-day readmission was 12 days, 10 days, and 12 days for patients initially hospitalized with heart failure, acute myocardial infarction, or pneumonia, respectively, and was comparable across common readmission diagnoses. Neither readmission diagnoses nor timing substantively varied by age, sex, or race. Among Medicare Fee-for-Service beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia, 30-day readmissions are frequent throughout the month following hospitalization and result from a similar spectrum of readmission diagnoses regardless of age, sex, race, or time after discharge.
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DOI：
10.1161/circoutcomes.110.957613
发表时间：
2010-09-01
影响因子：
6.9
作者：
Bernheim, Susannah M.;Grady, Jacqueline N.;Krumholz, Harlan M.
通讯作者：
Krumholz, Harlan M.
影响因子：
2.6
作者：
Lindenauer, Peter K.;Normand, Sharon-Lise T.;Krumholz, Harlan M.
通讯作者：
Krumholz, Harlan M.
DOI：
10.1056/nejmoa1010029
发表时间：
2010-12-09
期刊：
The New England journal of medicine
影响因子：
--
作者：
Chaudhry SI;Mattera JA;Curtis JP;Spertus JA;Herrin J;Lin Z;Phillips CO;Hodshon BV;Cooper LS;Krumholz HM
通讯作者：
Krumholz HM
影响因子：
4.8
作者：
Kiyota, Y;Schneeweiss, S;Solomon, DH
通讯作者：
Solomon, DH
影响因子：
37.8
作者：
Koehler, Friedrich;Winkler, Sebastian;Anker, Stefan D.
通讯作者：
Anker, Stefan D.