Inter-hospital transfers of patients with systemic lupus erythematosus: characteristics, predictors, and outcomes.
Inter-hospital transfers of patients with systemic lupus erythematosus: characteristics, predictors, and outcomes.
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发表时间：
2006-08
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通讯作者：
M. Ward;Jennifer Odutola
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作者：
M. Ward;Jennifer Odutola
目的描述系统性红斑狼疮(SLE)患者医院间转移的原因，找出转移的预测因素，比较转移和未转移患者的住院死亡风险。方法从州卫生规划机构获得2000-2002年纽约和宾夕法尼亚州SLE患者的急性护理住院数据。我们根据出院和入院代码确定了医院间转院，并对转院的主要原因(康复、手术或继续医疗)进行了分类。患者和医院的特征被视为转移的预测因子。我们使用匹配的队列设计和倾向调整来比较转院接受继续医疗护理的患者和未转院的患者的住院死亡率。结果我们确定了490名患者中的533名医院间转院，其中524名患者在每个住院期间涉及一次转院。在这524宗转院个案中，122宗(23.3%)为康复治疗，158宗(30.1%)为手术转院，244宗(46.6%)为继续治疗。患者特征和转院目的地在这些人群中各不相同。在较年轻的患者、病情较重、有急诊或紧急入院、或在较小的农村或非教学医院住院的患者中，或在宾夕法尼亚州，转院接受继续医疗护理的情况更常见，而在自有医院的患者中则不太常见。在配对队列分析中，转移者的住院死亡率风险是未转移者的2.25倍(95%可信区间为1.31，3.85；p=0.004)。这一风险与收治医院主治医生的经验不同：在每年治疗3名或3名以下系统性红斑狼疮患者的医生的患者中，这一风险是对照组的2.5倍(95%可信区间1.42，4.36；p=0.002)，而在每年治疗3名以上系统性红斑狼疮患者的医生中，这一风险是匹配对照组的0.56倍(95%可信区间0.06，5.12；p=0.62)。结论转诊原因不同，患者和转诊医院的特点也不同。转移继续医疗护理与较高的住院死亡率风险相关，但这些风险可能与接收医院的主治医生的SLE相关经验不同。
OBJECTIVE To describe the reasons for inter-hospital transfers of patients with systemic lupus erythematosus (SLE), to identify predictors of transfers, and to compare the risk of in-hospital mortality between patients who were transferred and those not transferred. METHODS Data on acute care hospitalizations of patients with SLE in New York and Pennsylvania in 2000-2002 were obtained from state health planning agencies. We identified inter-hospital transfers from discharge and admission codes, and categorized the major reason for transfer (rehabilitation, procedure, or continued medical care). Patient and hospital characteristics were examined as predictors of transfers. We used a matched cohort design with propensity adjustment to compare in-hospital mortality between patients transferred for continued medical care and those who were not transferred. RESULTS We identified 533 inter-hospital transfers in 490 patients, 524 of which involved one transfer per hospitalization episode. Of these 524 transfers, 122 (23.3%) were for rehabilitation, 158 (30.1%) were for procedures, and 244 (46.6%) were for continued medical care. Patient characteristics and transfer destinations varied among these groups. Transfers for continued medical care were more common among younger patients, those who were more severely ill, had an emergency or urgent admission, or were hospitalized in a smaller, rural or non-teaching hospital, or in Pennsylvania, and were less common among those at proprietary hospitals. In the matched cohort analysis, the risk of in-hospital mortality was 2.25 times higher (95% confidence interval 1.31, 3.85; p = 0.004) among those transferred compared with those who were not transferred. This risk differed with the experience of the attending physician at the receiving hospital: among patients of physicians who treated 3 or fewer patients with SLE per year, this risk was 2.5 times higher (95% CI 1.42, 4.36; p = 0.002), while among patients of physicians who treated more than 3 patients with SLE per year, this risk was 0.56 times (95% CI 0.06, 5.12; p = 0.62) that of matched controls. CONCLUSION Patient and transferring hospital characteristics vary with the reason for transfer. Transfers for continued medical care are associated with higher risks of in-hospital mortality, but these risks may differ with the SLE-related experience of the attending physician at the receiving hospital.