Age trends in 30 day hospital readmissions: US national retrospective analysis.
Age trends in 30 day hospital readmissions: US national retrospective analysis.
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DOI：
10.1136/bmj.k497
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发表时间：
2018-02-27
期刊：
影响因子：
--
通讯作者：
Hall M
中科院分区：
文献类型：
--
作者：
Berry JG;Gay JC;Joynt Maddox K;Coleman EA;Bucholz EM;O'Neill MR;Blaine K;Hall M
评估各年龄段再入院的趋势和风险因素。回顾性分析。31 729 762索引医院入院的所有条件在2013年从美国机构医疗保健研究和质量全国再入院数据库。30天，全因，计划外再入院。采用logistic回归分析，根据患者的年龄、性别、付款人、住院时间、出院处置、慢性疾病数量、入院原因和严重程度以及医院的数据聚类，比较患者一年内再入院的几率。选择年龄范围（0 - 90+岁）的中间年龄组（45岁）作为年龄参考组。所有美国指数入院后30天计划外再入院率为11.6%（n = 3 678 018）。以45岁的患者为参照，16岁至20岁之间再入院的调整优势比增加（从0.70（95%置信区间0.68至0.71）至1.04（1.02至1.06）），在21至44岁之间保持升高（范围1.02（1.00至1.03）至1.12（1.10至1.14）），在46至64岁之间稳步下降（范围1.02（1.00~1.04）~0.91（0.90~0.93）），65岁时突然下降（0.78（0.77~0.79）），之后随着年龄的增长，比值保持相对恒定。在所有年龄段中，多种慢性病与调整后的再入院几率最高相关（例如，6种或6种以上慢性病与无慢性病相比为3.67（3.64至3.69））。在儿童、年轻人和中年人中，心理健康是指数入院的最常见原因之一，具有较高的调整后再入院率（≥第75百分位数）。对于过渡到成年的儿童，患有精神健康障碍的儿童和年轻人以及患有多种慢性疾病的所有年龄段的患者，再入院的可能性增加。有必要进一步关注这些群体重新接纳的衡量标准和原因以及减少重新接纳的机会。
To assess trends in and risk factors for readmission to hospital across the age continuum. Retrospective analysis. 31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database. 30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients’ age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group. The 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile). The likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the measurement and causes of readmission and opportunities for its reduction in these groups is warranted.
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