Medication Regimen Complexity and Hospital Readmission for an Adverse Drug Event
Medication Regimen Complexity and Hospital Readmission for an Adverse Drug Event
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DOI：
10.1177/1060028013510898
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发表时间：
2014-01-01
影响因子：
2.9
通讯作者：
Weeks, Douglas L.
中科院分区：
文献类型：
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作者：
Willson, Megan N.;Greer, Christopher L.;Weeks, Douglas L.
背景：药物不良事件（ADE）是昂贵的，危险的，而且通常是可以预防的。关于药物治疗方案复杂性与ADE导致的再住院之间的联系知之甚少。目的：本研究的目的是比较2个队列的入院和出院用药方案复杂性：30天内因ADE再次入院的患者和未因ADE再次入院的患者。方法：本研究采用回顾性平行组病例对照设计。来自4家城市急性护理医院的参与者如果在30天内因编码为意外中毒的不良事件而再次住院，则被纳入再访队列。无重访队列是通过随机抽样与重访组具有相同疾病分类代码但在30天内没有再入院史的患者而形成的。采用药物治疗方案复杂性指数（MRCI）对入院和出院时药物治疗方案的复杂性进行量化。结果：重访组92人，未重访组228人。再访组在入院和出院时的MRCI评分显著高于未再访组（均P <0.005）。用于确定ADE风险的潜在MRCI临界评分的受试者工作特征曲线显示，MRCI评分为8分或更高，可最佳预测ADE导致的再入院风险增加。结论：入院时复杂的药物治疗方案是ADE再住院的预测因素。这一发现表明，药物治疗方案的复杂性被认为是一个目标的干预措施，以减少再入院的风险。
Background: Adverse drug events (ADEs) are costly, dangerous, and often preventable. Little is known about the link between medication regimen complexity and rehospitalization as a result of an ADE. Objective: The objective of this study was to compare admission and discharge medication regimen complexity in 2 cohorts: patients readmitted for an ADE within 30 days and patients not readmitted for an ADE. Methods: The study used a retrospective parallel-group case-control design. Participants from 4 urban acute care hospitals were included in the revisit cohort if they were rehospitalized within 30 days as a result of an adverse event coded as accidental poisoning. The no-revisit cohort was formed by randomly sampling patients with the same disease classification codes as the revisit group but without history of a readmission within 30 days. Complexity of medication regimens at the initial admission and discharge was quantified with the medication regimen complexity index (MRCI). Results: The revisit group comprised 92 individuals and the no-revisit group, 228. The revisit group had a significantly higher MRCI score at admission and discharge than the no-revisit group (all P < .005). Receiver operating characteristic curves, used to determine a potential MRCI cutoff score for risk of an ADE, revealed MRCI scores of 8 or greater to optimally predict increased risk for readmission caused by an ADE. Conclusions: Complex medication regimens at hospital admission are predictive of rehospitalizations for ADEs. This finding suggests that medication regimen complexity be considered as a target for interventions to decrease the risk for readmission.