从出院到再接收的时间对结果的影响:来自美国国家再接收数据库的观察研究
Jean-Sebastien Rachoin1, Krystal Hunter2,3, Jennifer Varallo3
1Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA Rachoin-jean@cooperhealth.edu.
BMJ open
|August 29, 2024
概括
医院再接收减少计划 (HRRP) 降低了大多数疾病的再接收率,但不是CABG或THA. 早期再入院显著增加了患者死亡风险.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 临床结果研究研究
背景情况:
- 医院再接收减少计划 (HRRP) 旨在减少急性心肌梗塞 (AMI),慢性阻塞性肺病 (COPD),心力衰竭 (HF),肺炎 (PNA),冠状动脉旁路移植 (CABG),选择性全关节整形术 (THA) 和全膝关节整形术 (TKA) 等疾病的再接收.
- 了解HRRP对再接收率和相关患者结果的长期影响,对于医疗保健政策和质量改善至关重要.
研究的目的:
- 评估HRRP对2010年至2019年期间特定条件的再接收率的影响.
- 调查医院再入院时间和患者结果 (如死亡率和入院时间 (LOS)) 之间的关系.
主要方法:
- 一项基于人口的回顾性研究,利用2010年至2019年美国国家再接收数据库 (NRD) 的数据.
- 使用线性回归模型分析了再接收状态,时间,死亡率和LOS之间的关联,与日志转换的LOS和用于正常化的收费.
主要成果:
- 分析了超过3100万名患者的病历,30天再入院率为14.55%.
- 对于COPD,HF,PNA,AMI和TKA来说,再接收率有所下降,但对于CABG和THA来说,它有所增加.
- 重新入院的患者面临更高的死亡率 (6%对2.8%) 和更长的LOS. 在10天内再入院的患者与后来再入院的患者相比,死亡风险明显更高.
结论:
- 对于几个关键条件,HRRP已有效地降低了再接收率,尽管像CABG和THA这样的例外需要进一步关注.
- 医院再入院的时间是一个关键因素,早期的再入院会带来更大的死亡风险和更长的住院时间.
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