Factors associated with inpatient readmission among managed care enrollees with COPD.
Factors associated with inpatient readmission among managed care enrollees with COPD.
复制标题
DOI：
10.1080/21548331.2015.1085797
复制
发表时间：
2015-01-01
影响因子：
--
通讯作者：
Kaila, Shuchita
中科院分区：
文献类型：
--
作者：
Candrilli, Sean D;Dhamane, Amol D;Kaila, Shuchita
目的：评估与美国慢性阻塞性肺疾病（COPD）管理护理人群中住院患者再入院相关的因素。背景：COPD常伴有间歇性急性加重，可能导致住院。这些急性发作通常与随后急性发作的频率增加相关，这可能导致住院患者再次入院。我们评估了主要诊断为COPD住院的≥40岁入组者的美国管理式医疗索赔数据（ICD-9-CM编码491.xx、492.xx或496.xx）（首次观察住院患者的出院日期定义为“索引日期”）。要求患者在索引日期前连续入组≥12个月。分析了两个非互斥队列：（1）索引日期后连续入组≥30天的患者（以评价30天再入院）和（2）索引日期后连续入组≥90天的患者（以评价90天再入院）。Logistic回归分析评估患者特征与30天和90天COPD相关和全因再入院风险之间的相关性。结果：应用选择标准后，140，981例患者的入组日期≥30天，123，545例患者的入组日期≥90天。在30天内，近20%的患者有全因再入院，7%的患者有COPD相关再入院。在90天内，28%的患者有全因再入院，12%的患者有COPD相关再入院。Logistic回归分析显示，住院时间越长、年龄越大、合并症负担越重、特定合并症和COPD复杂性与COPD相关30天和90天再入院的几率显著增加相关。全因再入院的结果一般similar.CONCLUSIONS：许多因素与住院再入院记录在这里可以确定在出院，并可用于通知出院计划，最终目标是改善患者的预后，包括降低再入院的风险。
OBJECTIVE: To assess factors associated with inpatient readmission among a US managed care population with chronic obstructive pulmonary disease (COPD).BACKGROUND: COPD is often accompanied by intermittent acute exacerbations, which may result in hospitalizations. These exacerbations are often associated with an increased frequency of subsequent exacerbations, which may lead to inpatient readmissions.METHODS: We assessed US managed care claims data for enrollees≥40 years old with an inpatient admission with a primary diagnosis of COPD (ICD-9-CM codes 491.xx, 492.xx or 496.xx) between 1 January 2010 and 31 December 2013 (discharge date of first observed inpatient admission defined the "index date"). Patients were required to be continuously enrolled for ≥12 months before the index date. Two non-mutually exclusive cohorts were analyzed: (1) patients with ≥30 days of post-index date continuous enrollment (to evaluate 30-day readmission) and (2) patients with ≥90 days of post-index date continuous enrollment (to evaluate 90-day readmission). Logistic regression evaluated the association between patient characteristics and risk of 30- and 90-day COPD-related and all-cause readmission.RESULTS: After applying selection criteria, 140,981 patients had ≥30 days of enrollment post-index date, and 123,545 patients had ≥90 days of enrollment post-index date. Within 30 days, nearly 20% of patients had an all-cause readmission and 7% had a COPD-related readmission. Within 90 days, 28% had an all-cause readmission and 12% had a COPD-related readmission. Logistic regression indicated that longer length of stay, older age, greater comorbidity burden, specific comorbidities and COPD complexity were associated with significantly greater odds of COPD-related 30- and 90-day readmission. Results for all-cause readmission were generally similar.CONCLUSIONS: Many of the factors associated with inpatient readmission documented here can be ascertained at discharge and may be used to inform discharge plans, with the end goal of improving patient outcomes, including reducing the risk of readmission.