Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population-based study.
Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population-based study.
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癫痫患者的非选择性入院、出院处理和卫生服务利用：一项基于人群的研究。
DOI：
10.1111/epi.16642
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发表时间：
2020
期刊：
影响因子：
5.6
通讯作者：
Jetté,Nathalie
中科院分区：
文献类型：
--
作者：
Kwon,Churl-Su;Wong,Bonnie;Agarwal,Parul;Lin,Jung-Yi;Mazumdar,Madhu;Dhamoon,Mandip;Jetté,Nathalie
确定不良后果和检查癫痫患者非择期入院的趋势和原因将有利于优化患者护理和减少卫生服务利用。我们研究了癫痫与出院状态、住院死亡率、住院时间和费用的关系。我们还研究了10年的趋势和住院的原因，其中有和没有epileps. MethodsNonelectivehospitaladmission癫痫患者在2005 - 2014年全国住院患者样本（NIS）使用有效的国际疾病分类，第9次修订，临床修改（ICD-9-CM）的情况下定义。NIS是美国最大的所有支付方数据库，包括患者和医院水平变量，代表了一般人群的住院情况。提供了入院趋势和原因的描述性统计数据以及总结癫痫与感兴趣结果相关性的多变量回归分析。结果在2014年4，718，178例非选择性入院中，3.80%（n = 179，461）为癫痫患者。2005年至2014年，癫痫患者的入院人数从14636人增加到179461人（P< .0001）。与没有癫痫的人相比，癫痫患者的住院率更高，（比值比[OR] = 1.77，95%置信区间[CI]：1.72 - 1.81，P < .0001），未遵医嘱出院（OR = 1.48，95%CI：1.38 - 1.59，P < .0001），总费用增加4%（P< .0001）。癫痫、惊厥、肺炎、情绪障碍、脑血管疾病和败血症是癫痫患者入院的主要原因，未来的研究应集中于设计有针对性的医疗保健干预措施，减少癫痫患者的入院人数，降低医疗服务利用率，增加癫痫患者出院回家的几率。
ObjectiveIdentifying adverse outcomes and examining trends and causes of nonelective admissions among persons with epilepsy would be beneficial to optimize patient care and reduce health services utilization. We examined the association of epilepsy with discharge status, in‐hospital mortality, length‐of‐stay, and charges. We also examined 10‐year trends and causes of hospital admissions among those with and without epilepsy.MethodsNonelective hospital admission in persons with epilepsy was identified in the 2005‐2014 National Inpatient Sample (NIS) using a validated International Classification of Diseases, 9th Revision, Clinical Modification (ICD‐9‐CM) case definition. The NIS is the largest US all‐payer database including patient and hospital‐level variables, and represents hospitalizations in the general population. Descriptive statistics on trends and causes of admissions and multivariable regression analysis summarizing the association of epilepsy with the outcomes of interest are presented.ResultsOf 4 718 178 nonelective admissions in 2014, 3.80% (n = 179 461) were in persons with epilepsy. Admissions in persons with epilepsy increased from 14 636 to 179 461 (P< .0001) between 2005 and 2014. As compared to persons without epilepsy, hospital admissions in persons with epilepsy had higher odds of transfer to other facilities (odds ratio [OR] = 1.77, 95% confidence interval [CI]: 1.72‐1.81,P< .0001), being discharged against medical advice (OR = 1.48, 95% CI: 1.38‐1.59,P< .0001), and incurring 4% greater total charges (P< .0001). Epilepsy, convulsions, pneumonia, mood disorders, cerebrovascular disease, and septicemia were the top causes for admissions in those with epilepsy.SignificanceFuture research should focus on designing targeted health care interventions that decrease the number of hospital admissions, reduce health services utilization, and increase the odds of discharge home in people with epilepsy.