当前位置: X-MOL 学术BMJ › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Age trends in 30 day hospital readmissions: US national retrospective analysis
The BMJ ( IF 105.7 ) Pub Date : 2018-02-27 , DOI: 10.1136/bmj.k497
Jay G Berry , James C Gay , Karen Joynt Maddox , Eric A Coleman , Emily M Bucholz , Margaret R O’Neill , Kevin Blaine , Matthew Hall

Objective To assess trends in and risk factors for readmission to hospital across the age continuum.
Design Retrospective analysis.
Setting and participants 31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database.
Main outcome measure 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.
Results 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).
Conclusions 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.


中文翻译:

30天住院再住院的年龄趋势:美国国家回顾性分析

目的评估整个年龄段入院的趋势和危险因素。
设计回顾性分析。
设置和参加者来自美国卫生保健研究与质量全国复诊数据库的2013年所有情况的31 729 762指数医院入院率。
主要结果指标为30天,所有原因,计划外的再次住院。再入院的可能性根据患者在一年内的年龄进行逻辑回归比较,包括性别,付款人,住院时间,出院安排,慢性病数量,入院原因和严重程度以及医院的数据聚类。选择年龄范围(0-90 +岁)的中间(45岁)作为年龄参考组。
结果所有美国指数入场后的30天计划外入学率为11.6%(n = 3 678 018)。以45岁的患者为参考,调整后的再入院优势比在16至20岁之间有所增加(从0.70(95%置信区间0.68至0.71)增至1.04(1.02至1.06)),并在21至44岁之间持续升高(范围从1.02(1.00到1.03)到1.12(1.10到1.14)),并在46至64岁之间稳步下降(范围1.02(1.00到1.04)至0.91(0.90到0.93)),并在65岁时突然下降(0.78) (0.77至0.79)),之后随着年龄的增长,赔率保持相对恒定。在所有年龄段中,多种慢性疾病与调整后的再入院几率最高相关(例如,对于六个或更多慢性疾病,与没有慢性疾病相比,其再入院几率最高)(3.67(3.64至3.69)。在儿童,年轻人中
结论对于成年后的儿童,患有精神疾病的儿童和较年轻的成年人以及具有多种慢性病的所有年龄段的患者,再次入院的可能性均升高。有必要进一步关注这些人群的测量和再入院的原因以及减少其再次入院的机会。
更新日期:2018-02-27
down
wechat
bug