The relative effects of patient and hospital factors on postpartum readmissions
The relative effects of patient and hospital factors on postpartum readmissions
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DOI：
10.1038/s41372-018-0125-8
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发表时间：
2018-07-01
影响因子：
2.9
通讯作者：
Kaimal, Anjali J.
中科院分区：
文献类型：
--
作者：
Clapp, Mark A.;Little, Sarah E.;Kaimal, Anjali J.
目的确定患者和医院因素对医院产后再入院率的相对影响。研究设计这项回顾性队列研究使用2004年至2013年期间来自加州、佛罗里达和纽约的州住院患者数据库进行。我们使用卡方检验比较了低再入院率和高再入院率医院的患者和医院特征。风险调整后的30天再入院率计算患者，交付，医院的特点，以了解影响再入院的因素，使用固定和随机effectsmodels.Results低再入院率的医院患者更有可能是白色，有私人保险和较高的收入，并有较少的合并症。风险调整后再入院率最高的患者合并症包括高血压（范围，2.14-3.04%）、肥胖（1.78-2.94%）、早产/分娩（2.50-2.60%）和癫痫发作（1.78-3.35%）。分娩并发症与风险调整后的再入院率增加相关。与患者特征相比，医院特征对再入院风险没有深刻的影响。结论产科再入院更多地归因于患者和人口统计学特征，而不是医院特征。再入院指标为基础的激励措施可能最终惩罚医院提供高质量的护理，由于病人的特点，具体到他们的集水区。
Objective To determine the relative effects of patient and hospital factors on a hospital's postpartum readmission rate.Study design This retrospective cohort study was conducted using State Inpatient Databases from California, Florida, and New York between 2004 and 2013. We compared patient and hospital characteristics among hospitals with low and high readmission rates using chi(2) tests. Risk-adjusted 30-day readmission rates were calculated for patient, delivery, and hospital characteristics to understand factors affecting readmission using fixed and random effects models.Results Patients in hospitals with low readmission rates were more likely to be white, to have private insurance and higher incomes, and to have fewer comorbidities. The patient comorbidities with the highest risk-adjusted readmission rates included hypertension (range, 2.14-3.04%), obesity (1.78-2.94%), preterm labor/delivery (2.50-2.60%), and seizure disorder (1.78-3.35%). Delivery complications were associated with increased risk-adjusted readmission rates. Compared to patient characteristics, hospital characteristics did not have a profound impact on readmission risk.Conclusion Obstetric readmissions were more attributable to patient and demographic characteristics than to hospital characteristics. Readmission metric-based incentives may ultimately penalize hospitals providing high-quality care due to patient characteristics specific to their catchment area.