Readmission after hospitalization for congestive heart failure among Medicare beneficiaries
Readmission after hospitalization for congestive heart failure among Medicare beneficiaries
复制标题
DOI：
10.1001/archinte.157.1.99
复制
发表时间：
1997-01-13
影响因子：
--
通讯作者：
Hennen, J
中科院分区：
文献类型：
--
作者：
Krumholz, HM;Parent, EM;Hennen, J
背景：充血性心力衰竭是医疗保险受益人最常见的出院诊断。虽然几个单中心的研究表明，这些患者特别容易再入院，没有最近的研究，据我们所知，已经报道了大量的老年患者的再入院率与充血性心力衰竭在不同的频谱hospital.Objectives：要定义的再入院率为老年患者出院后的充血性心力衰竭发作。确定导致充血性心力衰竭患者再入院的诊断谱。为了确定患者和医院的特点与更高的可能性reincission.Methods：这项观察性研究，使用医疗保险管理文件，评估了再入院和死亡的所有幸存者在康涅狄格州的充血性心力衰竭住院从财政年度1991年至财政年度1994年。在研究期间，有17448名因充血性心力衰竭住院的幸存者。在指数入院后的6个月内，7596例患者（44%）至少再次入院一次。充血性心力衰竭是研究患者中最常见的再入院原因，占所有再入院的18%。在多变量分析中，再入院的重要预测因素包括男性（比值比[OR]，1.12; 95%置信区间[CI]，1.05-1.20），指标入院后6个月内至少有1次既往入院（OR，1.64; 95% CI，1.53-1.77），Deyo合并症评分大于1（OR，1.56; 95%CI，1.45-1.68），以及索引住院时间超过7天（OR，1.32; 95%CI，1.24-1.41）。虽然年龄是不是一个显着的预测再入院，它成为显着的模型与再入院或死亡的综合结果为因variable.Conclusion：再入院后，住院治疗充血性心力衰竭是常见的医疗保险受益人，几乎一半的患者在6个月内再入院。在一个共同的诊断中，这种惊人的再入院率要求努力进一步澄清再入院的决定因素，并制定策略，以防止这种不良后果。
Background: Congestive heart failure is the most common discharge diagnosis for Medicare beneficiaries. While several single-center studies have suggested that these patients are particularly vulnerable to readmission, no recent study, to our knowledge, has reported the readmission rates for a large number of elderly patients with congestive heart failure across a diverse spectrum of hospitals.Objectives: To define the readmission rate for elderly patients discharged after an episode of congestive heart failure. To determine the spectrum of diagnoses that are responsible for readmissions among patients with congestive heart failure. To identify patient and hospital characteristics associated with a higher likelihood of readmission.Methods: This observational study, using Medicare administrative files, evaluated readmission and death among all survivors of a hospitalization in Connecticut for congestive heart failure from fiscal year 1991 through fiscal year 1994.Results: There were 17 448 survivors of a hospitalization for congestive heart failure during the study period. In the 6 months following the index admission, 7596 patients (44%) were readmitted to a hospital at least once. Congestive heart failure was the most frequent reason for readmission among study patients, accounting for 18% of all readmissions. In the multivariable analysis, significant predictors of readmission included male sex (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.05-1.20), at least 1 prior admission within 6 months of the index admission (OR, 1.64; 95% CI, 1.53-1.77), Deyo comorbidity score of more than 1 (OR, 1.56; 95% CI, 1.45-1.68), and length of stay in the index hospitalization of more than 7 days (OR, 1.32; 95% CI, 1.24-1.41). While age was not a significant predictor of readmission, it became significant in a model with the combined outcome of readmission or death as the dependent variable.Conclusion: Readmission after a hospitalization for congestive heart failure is common among Medicare beneficiaries, with almost half of the patients readmitted within 6 months. This striking rate of readmission in a common diagnosis demands efforts to further clarify the determinants of readmission and develop strategies to prevent this adverse outcome.