Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation
Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation
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DOI：
10.1186/s12890-020-1136-8
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发表时间：
2020-04-29
影响因子：
3.1
通讯作者：
Hasegawa, Kohei
中科院分区：
文献类型：
--
作者：
Goto, Tadahiro;Yoshida, Kazuki;Hasegawa, Kohei
背景调查在因COPD住院的患者中，社会因素的增加是否可以提高对总体30天再入院、早期再入院（出院后7天内）和晚期再入院（出院后8-30天）风险的预测能力）。方法在2006年至2012年的医疗保险当前受益调查中确定了因COPD住院的患者（年龄≥ 40岁）。通过使用来自原始队列（训练集）的1000个自助回归，推导出两个预测模型：1）包括年龄、合并症和机械通气使用的参考模型，和2）包括社会因素（例如，教育水平、婚姻状况）以及参考模型中的协变量。分别对30天、早期和晚期再入院的预测性能进行了检查。结果：905例COPD住院患者中，18.5%在30天内再次入院。在测试集中，对于总体30天再入院，参考模型和优化模型之间的区分能力没有实质性变化（C统计量，0.57 vs. 0.58）。相比之下，对于早期再入院，优化模型显著改善了区分度（C-统计量，0.57 vs. 0.63;综合区分度改善[IDI]，0.018 [95%CI，0.003-0.032]）和重新分类（连续净重新分类指数[NRI]，0.298 [95%CI 0.060-0.537]）。同样，对于晚期再入院，优化模型也显著改善了区分度（C-统计量，0.65 vs. 0.68; IDI，0.026 [95%CI 0.009-0.042]）和重新分类（连续NRI，0.243 [95%CI 0.028-0.459]）。结论：在一个具有全国代表性的因COPD住院的医疗保险受益人样本中，我们发现，当分别检查早期和晚期再入院时，社会因素的加入提高了再入院的预测能力。
Background To investigate whether, in patients hospitalized for COPD, the addition of social factors improves the predictive ability for the risk of overall 30-day readmissions, early readmissions (within 7 days after discharge), and late readmissions (8-30 days after discharge). Methods Patients (aged >= 40 years) hospitalized for COPD were identified in the Medicare Current Beneficiary Survey from 2006 through 2012. With the use of 1000 bootstrap resampling from the original cohort (training-set), two prediction models were derived: 1) the reference model including age, comorbidities, and mechanical ventilation use, and 2) the optimized model including social factors (e.g., educational level, marital status) in addition to the covariates in the reference model. Prediction performance was examined separately for 30-day, early, and late readmissions. Results Following 905 index hospitalizations for COPD, 18.5% were readmitted within 30 days. In the test-set, for overall 30-day readmissions, the discrimination ability between reference and optimized models did not change materially (C-statistic, 0.57 vs. 0.58). By contrast, for early readmissions, the optimized model had significantly improved discrimination (C-statistic, 0.57 vs. 0.63; integrated discrimination improvement [IDI], 0.018 [95%CI, 0.003-0.032]) and reclassification (continuous net reclassification index [NRI], 0.298 [95%CI 0.060-0.537]). Likewise, for late readmissions, the optimized model also had significantly improved discrimination (C-statistic, 0.65 vs. 0.68; IDI, 0.026 [95%CI 0.009-0.042]) and reclassification (continuous NRI, 0.243 [95%CI 0.028-0.459]). Conclusions In a nationally-representative sample of Medicare beneficiaries hospitalized for COPD, we found that the addition of social factors improved the predictive ability for readmissions when early and late readmissions were examined separately.