Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study.
Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study.
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DOI：
10.7326/m13-2946
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发表时间：
2014-12-02
影响因子：
39.2
通讯作者：
Smith M
中科院分区：
文献类型：
--
作者：
Kind AJ;Jencks S;Brock J;Yu M;Bartels C;Ehlenbach W;Greenberg C;Smith M
衡量社会经济不利因素可能有助于提高预防再住院计划的针对性，但直接从患者那里获得此类信息可能很困难。美国邻里社会经济劣势的措施更容易获得，虽然很少在临床上使用。评估人口普查区块组水平上社区社会经济劣势（通过辛格验证的区域残疾指数（ADI）测量）与30天再住院之间的关联。回顾性队列研究美国随机5%的全国性按服务收费医疗保险患者出院充血性心力衰竭，肺炎或心肌梗死，2004-2009年（N = 255，744）30天再住院。将医疗保险数据与2000年人口普查数据联系起来，为每个患者的人口普查区块组构建ADI，然后通过增加ADI将其分类为数字。使用多变量逻辑回归模型评估社区ADI分组与再住院之间的关系，控制患者的社会人口统计学、合并症/严重程度和指标医院特征。30天再住院率在最不弱势的85%社区之间没有显著差异，平均再住院率= 21%。然而，在最弱势的15%的社区，随着ADI的恶化，再住院率从22%上升到27%。这种关系在完全调整后仍然存在，最弱势社区的再住院风险（调整后的风险比= 1.09，置信区间1.05-1.12）与慢性肺病（1.06，1.04-1.08）相似，高于糖尿病（0.95，0.94-0.97）。没有直接的护理质量指标，访问居住在一个不利的美国社区是一个再住院的预测因素，其程度类似于慢性肺病。邻里劣势的衡量标准，如ADI，可能被用来为政策和出院后护理提供信息。国家老龄化研究所
Measures of socioeconomic disadvantage may enable improved targeting of programs to prevent rehospitalizations, but obtaining such information directly from patients can be difficult. Measures of US neighborhood socioeconomic disadvantage are more readily available, although rarely employed clinically. To evaluate the association between neighborhood socioeconomic disadvantage at the census block-group level, as measured by Singh’s validated Area Deprivation Index (ADI), and 30-day rehospitalization. Retrospective cohort study United States Random 5% national sample of fee-for-service Medicare patients discharged with congestive heart failure, pneumonia or myocardial infarction, 2004–2009 (N = 255,744) 30-day rehospitalizations. Medicare data were linked to 2000 Census data to construct an ADI for each patient’s census block-group, which were then sorted into percentiles by increasing ADI. Relationships between neighborhood ADI grouping and rehospitalization were evaluated using multivariate logistic regression models, controlling for patient sociodemographics, comorbidities/severity, and index hospital characteristics. The 30-day rehospitalization rate did not vary significantly across the least disadvantaged 85% of neighborhoods, which had an average rehospitalization rate=21%. However, within the most disadvantaged 15% of neighborhoods, rehospitalization rates rose from 22% to 27% with worsening ADI. This relationship persisted after full adjustment, with the most disadvantaged neighborhoods having a rehospitalization risk (adjusted risk ratio = 1.09, confidence interval 1.05–1.12) similar to that of chronic pulmonary disease (1.06, 1.04–1.08) and greater than that of diabetes (0.95, 0.94–0.97). No direct markers of care quality, access Residence within a disadvantaged US neighborhood is a rehospitalization predictor of magnitude similar to chronic pulmonary disease. Measures of neighborhood disadvantage, like the ADI, could potentially be used to inform policy and post-hospital care. National Institute on Aging