Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan
Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan
复制标题
DOI：
10.1016/s0002-9343(99)00159-x
复制
发表时间：
1999-07-01
影响因子：
5.9
通讯作者：
Brennan, TA
中科院分区：
文献类型：
--
作者：
Marcantonio, ER;McKean, S;Brennan, TA
目的：出院后30天内非计划的再次住院被认为是质量差的“哨兵事件”。这种不良事件的高危患者可以针对他们进行干预，以降低他们再次住院的风险。这项研究的目的是确定出院后30天内非计划再入院的患者的特征和危险因素。材料和方法：我们在一项医疗保险管理护理计划中住进一家学术医院的患者中进行了一项配对的病例对照研究。这些病例是65岁或以上的患者，他们在出院后30天内紧急或紧急再次入院。根据主要诊断，每个病例匹配一名30天内未再次入院的对照患者。对首次入院病例和对照组入院的医疗记录进行复查(病例对照状态为盲目)，以确定患者的基线人口学特征、并存情况、既往卫生保健利用情况和功能状态。结果：临床不稳定、不能走动和进食、精神状态改变、出院用药次数和出院倾向5个因素独立相关(P
PURPOSE: Unplanned hospital readmission within 30 days of discharge is considered a "sentinel event" for poor quality. Patients at high risk for this adverse event could be targeted for interventions designed to reduce their risk of readmission. The purpose of this study was to identify patient characteristics and risk factors at discharge associated with unplanned readmission within 30 days of hospital discharge.SUBJECTS AND METHODS: We performed a matched case-control study among patients in a Medicare managed care plan who had been admitted to an academic hospital. The cases were patients aged 65 years or older who were urgently or emergently readmitted to the hospital within 30 days of discharge. One control patient who was not readmitted within 30 days was matched to each case by principal diagnosis. The medical records of the first admission of the cases and the admission of the controls underwent review (blinded to case-control status) to determine the patient's baseline demographic characteristics, comorbid conditions, previous health care utilization, and functional status. The records were also reviewed to assess risk factors on discharge, including clinical instability, inability to ambulate and feed, mental status changes, number of discharge medications, and discharge disposition.RESULTS: Five factors were independently associated (P