Comparison between planned and unplanned readmissions to a department of internal medicine
Comparison between planned and unplanned readmissions to a department of internal medicine
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DOI：
10.1016/s0895-4356(98)00142-5
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发表时间：
1999-02-01
影响因子：
7.2
通讯作者：
Gaspoz, JM
中科院分区：
文献类型：
--
作者：
Kossovsky, MP;Perneger, TV;Gaspoz, JM
本研究的目的是评估内科出院后计划内和计划外早期再入院的频率，并识别和比较这两种类型再入院的风险因素。根据对出院摘要的分析，确定出院 31 天内的再入院是计划内的还是计划外的。使用时间失败方法来描述随时间推移的再入院风险，并评估患者和指数停留特征与再入院风险之间的关系。在 5828 名活着出院的患者中，730 名（12.5%）在 31 天内再次入院。计划再入院人数略多于计划外再入院人数（393 例与 337 例）。事件发生时间函数的差异显着（P = 0.04）。男性、年轻患者以及诊断出冠心病、心律失常和肿瘤性疾病的出院患者的计划再入院风险增加。非计划再入院的风险增加与指数住院时间超过 3 天、合并症数量增加以及肿瘤疾病的诊断有关。计划再入院人数占我们内科早期再入院人数的一半以上。因此，粗略的再入院竞赛不太可能成为护理质量的有用指标。一些患者特征会影响计划外再入院的风险，这表明在比较机构之间的再入院率或随时间跟踪再入院率时，有必要进行病例组合调整。 J CLIN Epidemiol 52;2:151-156, 1999。(C) 1999 Elsevier Science Inc.
The objective of this study was to assess the respective frequency of planned and unplanned early readmissions after discharge from an internal medicine department, and to identify and compare risk factors for these two types of readmissions. Readmissions within 31 days of discharge were identified as planned or unplanned based on analysis of discharge summaries. Time-failure methods were used to describe the risk of readmissions over time and to assess relationships between patient and index stay characteristics and risk of readmission. Of 5828 patients discharged alive, 730 (12.5%) were readmitted within 31 days. There were slightly more planned than unplanned readmissions (393 vs. 337). The difference in time-to-event functions was significant (P = 0.04). The risk of planned readmission was increased for men, younger patients, and for patients discharged with a diagnosis of coronary heart disease, cardiac arrhythmia, and neoplastic disease. Increased risk of unplanned readmission was associated with index length of stay longer than 3 days, an increased number of comorbidities, and with a diagnosis of neoplastic disease. Planned readmissions constitute more than half of early readmissions to our internal medicine department. Therefore, a crude readmission race is unlikely to be a useful indicator of quality of care. Several patient characteristics influence the risk of unplanned readmission, suggesting that case-mix adjustments are necessary when readmission rates are compared between institutions or tracked over time. J CLIN EPIDEMIOL 52;2:151-156, 1999. (C) 1999 Elsevier Science Inc.