Predictors and outcomes of unplanned readmission to a different hospital
Predictors and outcomes of unplanned readmission to a different hospital
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DOI：
10.1093/intqhc/mzv082
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发表时间：
2015-12-01
影响因子：
2.6
通讯作者：
Boockvar, Kenneth
中科院分区：
文献类型：
--
作者：
Kim, Hongsoo;Hung, William W.;Boockvar, Kenneth
目的：检查与同一医院相比，与重新入院到不同医院相关的患者、医院和市场因素以及结果。设计：使用多层次因果模型进行基于人群的二次分析。设置：美国加州的急性护理医院。参与者：总共有509 775名50岁或以上的患者从急症护理医院活着出院（指标住院），59 566人在指标出院后30天内再次住院。干预措施：无干预。主要结果测量：30天的计划外再入院到不同的医院相比，同一家医院，也是成本和健康的reincmissions.Results结果：21%的患者再住院有不同的医院再入院。与同一医院再入院组相比，不同医院再入院组更可能是年轻、男性和收入较低。不同医院再入院组的指标医院更有可能是规模较小的营利性医院，这些医院也更有可能位于竞争激烈的县。不同医院的再入院组有更高的院内死亡几率（8.1 vs. 6.7%; P < 0.0001）和更高的再入院医院成本（15 671.8 vs. 14 286.4; P < 0.001）比同一医院再入院group.Conclusions：患者、医院和市场特征预测不同医院的再入院与同一医院的再入院相比。不同医院再入院患者的死亡率和费用结局更差。有必要针对不同医院再入院风险人群制定更好的护理协调策略。
Objectives: To examine patient, hospital and market factors and outcomes associated with readmission to a different hospital compared with the same hospital.Design: A population-based, secondary analysis using multilevel causal modeling.Setting: Acute care hospitals in California in the USA.Participants: In total, 509 775 patients aged 50 or older who were discharged alive from acute care hospitals (index hospitalizations), and 59 566 who had a rehospitalization within 30 days following their index discharge. Intervention: No intervention.Main Outcome Measures(s): Thirty-day unplanned readmissions to a different hospital compared with the same hospital and also the costs and health outcomes of the readmissions.Results: Twenty-one percent of patients with a rehospitalization had a different-hospital readmission. Compared with the same-hospital readmission group, the different-hospital readmission group was more likely to be younger, male and have a lower income. The index hospitals of the different-hospital readmission group were more likely to be smaller, for-profit hospitals, which were also more likely to be located in counties with higher competition. The different-hospital readmission group had higher odds for in-hospital death (8.1 vs. 6.7%; P < 0.0001) and greater readmission hospital costs ($15 671.8 vs. $14 286.4; P < 0.001) than the same-hospital readmission group.Conclusions: Patient, hospital and market characteristics predicted different-hospital readmissions compared with same-hospital readmissions. Mortality and cost outcomes were worse among patients with different-hospital readmissions. Strategies for better care coordination targeting people at risk for different-hospital readmissions are necessary.