Risk factors for hospital-acquired 'poor glycemic control': a case-control study
Risk factors for hospital-acquired 'poor glycemic control': a case-control study
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DOI：
10.1093/intqhc/mzq067
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发表时间：
2011-02-01
影响因子：
2.6
通讯作者：
Aiken, Linda H.
中科院分区：
文献类型：
--
作者：
McHugh, Matthew D.;Shang, Jingjing;Aiken, Linda H.
确定与“血糖控制不佳”严重表现相关的患者和医院特征。“血糖控制不佳”是美国医疗保险计划基于与糖尿病严重并发症相关的医院索赔定义的“无报酬”医院获得性疾病。一项巢式病例对照研究。加州2005年至2006年的急诊医院。所有病例（n= 261）2005年至2006年在加州急性护理医院入院时血糖控制不佳的患者和261名对照者进行了匹配（1：1）使用年龄、性别、主要诊断类别和疾病严重程度的管理数据。血糖控制不良的校正比值比（OR）。死亡在血糖控制不良的病例中，总费用（26 125美元对18 233美元，P= 0.026）显著较高。风险调整的条件Logistic回归显示，每增加一种慢性疾病，血糖控制不良的几率增加12%（OR：1.12，95%CI：1.04-1.22）。注册护士配备和医院教学状况的相互作用表明，在非教学医院，每个调整患者日每增加一个护理小时，血糖控制不良的几率显著降低16%（OR：0.84，95%CI：0.73-0.96）。教学医院的护士配备不显著（OR：0.98，95%CI：0.88-1.11）。严重血糖控制不良并发症相对罕见，但有意义的事件，不成比例的高成本和高死亡率。增加护理人员可能是减少血糖控制不良并发症的有效策略，特别是在非教学医院。
To determine the patient and hospital characteristics associated with severe manifestations of 'poor glycemic control'-a 'no-pay' hospital-acquired condition defined by the US Medicare program based on hospital claims related to severe complications of diabetes.A nested case-control study.California acute care hospitals from 2005 to 2006.All cases (n= 261) with manifestations of poor glycemic control not present on admission admitted to California acute care hospitals from 2005 to 2006 and 261 controls were matched (1:1) using administrative data for age, sex, major diagnostic category and severity of illness.The adjusted odds ratio (OR) for experiencing poor glycemic control.Deaths (16 vs. 9%, P= 0.01) and total costs ($26 125 vs. $18 233, P= 0.026) were significantly higher among poor glycemic control cases. Risk-adjusted conditional logistic regression revealed that each additional chronic condition increased the odds of poor glycemic control by 12% (OR: 1.12, 95% CI: 1.04-1.22). The interaction of registered nurse staffing and hospital teaching status suggested that in non-teaching hospitals, each additional nursing hour per adjusted patient day significantly reduced the odds of poor glycemic control by 16% (OR: 0.84, 95% CI: 0.73-0.96). Nurse staffing was not significant in teaching hospitals (OR: 0.98, 95% CI: 0.88-1.11).Severe poor glycemic control complications are relatively rare but meaningful events with disproportionately high costs and mortality. Increasing nurse staffing may be an effective strategy in reducing poor glycemic control complications particularly in non-teaching hospitals.