How Well Can Hospital Readmission Be Predicted in a Cohort of Hospitalized Children? A Retrospective, Multicenter Study
How Well Can Hospital Readmission Be Predicted in a Cohort of Hospitalized Children? A Retrospective, Multicenter Study
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DOI：
10.1542/peds.2007-3395
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发表时间：
2009-01-01
期刊：
影响因子：
8
通讯作者：
Hall, Matt
中科院分区：
文献类型：
--
作者：
Feudtner, Chris;Levin, James E.;Hall, Matt
背景患有复杂慢性病的儿童既依赖于他们的家庭，也依赖于儿科医疗保健、社会服务和融资系统。通过对未来住院可能性的人群水平预测的更准确方法，将推进对这种护理生态学工作的调查。这是一项回顾性队列研究。医院行政数据收集了38家儿童医院在美国的2003-2005年。参与者包括2004年期间从索引住院中出院的2至18岁的患者。纳入了首次住院期间或之前365天内任何既往住院期间记录的患者特征。主要的结局指标是从索引入院后365天内的再入院率。在2004年期间从参与医院出院的186856例患者组成的队列中，平均年龄为9.2岁，其中54.4%为男性，52.9%为非西班牙裔白色。在过去的365天内，共有17.4%的人入院，在活着出院的人中（0.6%在入院期间死亡），16.7%在随后的365天内再次入院。最终的再入院模型显示所有医院的c统计量为0.81，每家医院的范围为0.76至0.84。基于Bootstrap的评估证明了最终模型的稳定性。准确的人口水平的预测医院再入院是可能的，和由此产生的预测概率的医院再入院可能证明是有用的卫生服务的研究和规划。儿科2009;123：286-293
BACKGROUND. Children with complex chronic conditions depend on both their families and systems of pediatric health care, social services, and financing. Investigations into the workings of this ecology of care would be advanced by more accurate methods of population-level predictions of the likelihood for future hospitalization.METHODS. This was a retrospective cohort study. Hospital administrative data were collected from 38 children's hospitals in the United States for the years 2003-2005. Participants included patients between 2 and 18 years of age discharged from an index hospitalization during 2004. Patient characteristics documented during the index hospitalization or any previous hospitalization during the preceding 365 days were included. The main outcome measure was readmission to the hospital during the 365 days after discharge from the index admission.RESULTS. Among the cohort composed of 186 856 patients discharged from the participating hospitals during 2004, the mean age was 9.2 years, with 54.4% male and 52.9% identified as non-Hispanic white. A total of 17.4% were admitted during the previous 365 days, and among those discharged alive (0.6% died during the admission), 16.7% were readmitted during the ensuing 365 days. The final readmission model exhibited a c statistic of 0.81 across all hospitals, with a range from 0.76 to 0.84 for each hospital. Bootstrap-based assessments demonstrated the stability of the final model.CONCLUSIONS. Accurate population-level prediction of hospital readmissions is possible, and the resulting predicted probability of hospital readmission may prove useful for health services research and planning. Pediatrics 2009;123:286-293