Evaluation of factors and patterns influencing the 30-day readmission rate at a tertiary-level hospital in a resource-constrained setting in Cape Town, South Africa
Evaluation of factors and patterns influencing the 30-day readmission rate at a tertiary-level hospital in a resource-constrained setting in Cape Town, South Africa
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DOI：
10.7196/samj.2019.v109i3.13367
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发表时间：
2019-03-01
期刊：
影响因子：
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通讯作者：
Viljoen, A J
中科院分区：
文献类型：
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作者：
Dreyer, R;Viljoen, A J
背景。全世界范围内都对导致再入院的因素和原因进行了调查，但在南非 (SA) 进行的研究很少，在西开普省也没有进行过研究。 目标。旨在调查出院后 30 天内导致开普敦 Tygerberg 医院 (TBH) 内科再次入院的可能可预防和不可预防因素。研究人员测试了风险分层工具（LACE 指数），以评估该工具在 TBH 系统中的性能。方法。对 2014 年 1 月 1 日至 2015 年 3 月 31 日期间 TBH 内科的所有 30 天再入院（首次住院和 30 天内再次住院）进行了回顾性分析。记录了导致再入院的潜在危险因素。结果。共有 11 826 名入院记录。其中，30天内再入院1 242人，再入院率为10.5%。大多数患者 (66%) 在出院后 14 天内再次入院。再入院最重要的风险因素是合并症的数量，使用查尔斯顿评分进行评估。该研究还发现，由于系统相关问题，可能会导致大量可避免的原因（35％的再入院），其中最常见的是过早出院。 30天再入院的其他原因包括医院感染、药物不良反应，尤其是华法林毒性、出院计划不充分和医生失误。结论。尽管 TBH 是一个资源匮乏、周转率高的系统，但 30 天的再入院率经计算为 10.5%。全球再入院率从 10% 到 25% 不等，具体取决于所使用的参考文章/来源。我们发现 35% 的 30 天再入院是可以避免的。静脉血栓栓塞是导致再入院的次要原因，但与非常高的死亡率相关。评估的次要结果是 LACE 和修改后的 LACE (mLACE) 指数在 TBH 环境中的效用。该风险工具在 TBH 人群中表现良好，高 LACE 和 mLACE 评分与 30 天再入院风险增加相关 (p
Background. Factors contributing to and causes of hospital readmissions have been investigated worldwide, but very few studies have been performed in South Africa (SA) and none in the Western Cape Province.Objectives. To investigate possible preventable and non-preventable factors contributing to readmissions to the Department of Internal Medicine at Tygerberg Hospital (TBH), Cape Town, within 30 days of hospital discharge. The researchers tested a risk-stratification tool (the LACE index) to evaluate the tool's performance in the TBH system.Methods. A retrospective analysis was conducted of all 30-day readmissions (initial hospitalisation and rehospitalisation within 30 days) to the Department of Internal Medicine at TBH for the period 1 January 2014 - 31 March 2015. Potential risk factors leading to readmission were recorded.Results. A total of 11 826 admissions were recorded. Of these patients, 1 242 were readmitted within 30 days, representing a readmission rate of 10.5%. The majority of patients (66%) were readmitted within 14 days after discharge. The most important risk factor for readmission was the number of comorbidities, assessed using the Charlston score. The study also identified a large burden of potentially avoidable causes (35% of readmissions) due to system-related issues, premature discharge being the most common. Other reasons for 30-day readmission were nosocomial infection, adverse drug reactions, especially warfarin toxicity, inadequate discharge planning and physician error.Conclusions. Despite TBH being a low-resource, high-turnover system, the 30-day readmission rate was calculated at 10.5%. Global readmission rates vary from 10% to 25%, depending on the reference article/source used. We found that 35% of 30-day readmissions were potentially avoidable. Venous thromboembolism was a minor contributor to readmission but was associated with a very high mortality rate. A secondary outcome evaluated was the utility of the LACE and modified LACE (mLACE) index in the TBH environment. The risk tool performed well in the TBH population, and a high LACE and mLACE score correlated with an increased risk of 30-day readmission (p