SCREENING ELDERS FOR RISK OF HOSPITAL ADMISSION
SCREENING ELDERS FOR RISK OF HOSPITAL ADMISSION
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DOI：
10.1111/j.1532-5415.1993.tb06175.x
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发表时间：
1993-08-01
影响因子：
6.3
通讯作者：
KRULEWITCH, H
中科院分区：
文献类型：
--
作者：
BOULT, C;DOWD, B;KRULEWITCH, H
目的：定义一套筛查标准，以确定哪些老年人是未来再次住院的高危人群。设计：纵向队列研究。对一半受试者的数据进行Logistic回归分析，以确定重复住院的危险因素。然后，使用来自另一半受试者的数据测试这些危险因素识别未来重复住院的高危老年人的能力。地点：美国。参与者：1984年所有70岁或以上的非住院美国平民的多阶段概率样本的子样本(n=5876)。测量：在基线(1984)时，老年受试者被问及他们的人口统计、社会经济、医学和功能特征以及他们最近的健康使用情况。服务。然后通过医疗保险计划和国家死亡指数(1985-88)的记录监测他们随后的入院和死亡率。结果：在前一半样本中，8个因素成为重复入院的危险因素：年龄、男性、性别、自评总体健康状况差、是否有非正式照顾者、曾患过冠状动脉疾病、前一年入院、6次以上就诊或糖尿病。根据1984年这些因素的存在或不存在，估计在1985-1988年期间，样本后一半的受试者中有7.2%的人有很高的重复入院概率(P(Ra)大于或等于0.5)。与估计为低风险(P(Ra)和0.5)的受试者相比，这一高危人群在1985年至1988年期间的实际经历包括：重复入院的累积发生率(41.8%比26.2%，P<；0.0001)，累积死亡率(44.2%比19.0%，P<；0.5)；0.0001)，人均年存活住院天数(5.2vs2.6)，人均年住院费用(37.31vs1841美元)。结论：8个易确定的危险因素影响老年人4年内再次住院的概率。将来，有关这些因素存在的简要调查可以用来估计老年人未来住院的风险，从而确定一些可能从旨在避免住院需求的干预措施中获得最大好处的人。
Objective: To define a set of screening criteria that identifies elders who are, at high risk for repeated hospital admission in the future.Design: Longitudinal cohort study. Logistic regression analysis of data from half of the subjects was used to identify risk factors for repeated hospital admission. The ability of these risk factors to identify elders who are at high risk for repeated hospitalization in the future was then tested using data from the other half of the subjects.Setting: United States.Participants: A subsample (n = 5876) of a multistage probability sample of all non-institutionalized U.S. civilians who were 70 years or older in 1984.Measurements: At baseline (1984), elderly subjects were asked about their demographic, socioeconomic, medical, and functional characteristics and about their recent use of health. services. Their subsequent hospital admissions and mortality were then monitored through the records of the Medicare program and the National Death Index (1985-88).Results: Among the subjects in the first half of the sample, eight factors emerged as risk factors for repeated admission: older age, male, sex, poor self-rated general health, availability of an informal caregiver, having ever had coronary artery disease, and having had, during the previous year, a hospital admission, more than six doctor visits, or diabetes. Based on the presence or absence of these factors in 1984, 7.2% of the subjects in the second half of the sample were estimated to have a high probability of repeated admission (P(ra) greater-than-or-equal-to 0.5) during 1985-1988. In comparison with subjects estimated to have a low risk (P(ra) < 0.5), this high-risk group's actual experiences during 1985-1988 included a higher cumulative incidence of repeated admission (41.8% vs 26.2%, P < 0.0001), a higher cumulative rate of mortality (44.2% vs 19.0%, P < 0.0001), more hospital days per person-year survived (5.2 vs 2.6), and higher hospital charges per person-year survived ($3731 vs $1841).Conclusion: Eight easily ascertained risk factors affect elders' probability of being hospitalized repeatedly within four years. In the future, brief surveys about the presence of these factors could be used to estimate elders' risk of future hospitalization and, thereby, to identify some of those who may derive the greatest benefit from interventions designed to avert the need for hospitalization.