Multimorbidity and healthcare resource utilization in Switzerland: a multicentre cohort study
Multimorbidity and healthcare resource utilization in Switzerland: a multicentre cohort study
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DOI：
10.1186/s12913-019-4575-2
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发表时间：
2019-10-17
影响因子：
2.8
通讯作者：
Donze, Jacques
中科院分区：
文献类型：
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作者：
Aubert, Carole E.;Fankhauser, Niklaus;Donze, Jacques
背景：多病与较高的医疗资源利用率相关，但我们缺乏关于合并症具体组合与医疗资源利用率之间关联的数据。我们的目的是确定多病住院患者中与高医疗资源利用率相关的合并症的组合。方法：我们进行了一项多中心回顾性队列研究，纳入了2010-2011年瑞士三家医院出院的33,871例多病（>= 2种慢性疾病）住院患者。医疗保健资源利用通过30天潜在可避免再入院（PAR）、延长住院时间（LOS）和中位LOS的差异来衡量。我们确定了与最高医疗资源利用率相关的慢性合并症的组合，并使用回归技术量化了这种关联。结果四分之三与PAR相关性最强的联合用药包括慢性肾脏疾病。急性和不明原因肾衰竭合并实体恶性肿瘤与PAR的相关性最强（OR 2.64, 95%CI 1.79;3.90）。杂项精神健康障碍合并情绪障碍与LOS（中位LOS差异：17天）和延长LOS （OR 10.77, 95%CI 8.38;13.84）的相关性最强。慢性疾病的数量与延长的LOS密切相关（OR 9.07, 95%CI 8.04; >= 10种慢性疾病时为10.24），与PAR的相关性较小（OR 2.16, 95%CI 1.75; >= 10种慢性疾病时为2.65）。结论：与PAR相比，多病对LOS的影响更大。与医疗保健利用最密切相关的合并症组合包括PAR的肾脏疾病和LOS的精神健康障碍。
Background Multimorbidity is associated with higher healthcare resource utilization, but we lack data on the association of specific combinations of comorbidities with healthcare resource utilization. We aimed to identify the combinations of comorbidities associated with high healthcare resource utilization among multimorbid medical inpatients. Methods We performed a multicentre retrospective cohort study including 33,871 multimorbid (>= 2 chronic diseases) medical inpatients discharged from three Swiss hospitals in 2010-2011. Healthcare resource utilization was measured as 30-day potentially avoidable readmission (PAR), prolonged length of stay (LOS) and difference in median LOS. We identified the combinations of chronic comorbidities associated with the highest healthcare resource utilization and quantified this association using regression techniques. Results Three-fourths of the combinations with the strongest association with PAR included chronic kidney disease. Acute and unspecified renal failure combined with solid malignancy was most strongly associated with PAR (OR 2.64, 95%CI 1.79;3.90). Miscellaneous mental health disorders combined with mood disorders was the most strongly associated with LOS (difference in median LOS: 17 days) and prolonged LOS (OR 10.77, 95%CI 8.38;13.84). The number of chronic diseases was strongly associated with prolonged LOS (OR 9.07, 95%CI 8.04;10.24 for >= 10 chronic diseases), and to a lesser extent with PAR (OR 2.16, 95%CI 1.75;2.65 for >= 10 chronic diseases). Conclusions Multimorbidity appears to have a higher impact on LOS than on PAR. Combinations of comorbidities most strongly associated with healthcare utilization included kidney disorders for PAR, and mental health disorders for LOS.