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30-Day Readmission and Emergency Department Visits: Experience of Diabetes and Abdominal Surgery Patients.

机译：30天再入院和急诊科就诊：糖尿病和腹部手术患者的经验。

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摘要

Nearly one-fifth of Medicare beneficiaries are readmitted within 30 days of a hospital stay. Readmissions contribute to the rising health care costs and they serve as a proxy for overall inpatient quality of care. Policy makers and payers interested in the efficacy of strategies to improve care coordination have scrutinized readmission rates for some time, yet this analysis attends to several remaining gaps in the literature. First, the rising prevalence of diabetes may be an underappreciated driver for readmissions. Second, many abdominal surgery patients require post-operative care, yet the point of care delivery and level of care needed has not been well described for these surgeries.;Two retrospective analyses were conducted: 1) 30-day readmissions among patients with and without diabetes, and 2) 30-day readmissions and emergency department (ED) visits among patients undergoing abdominal surgery. The study utilized 2008-2010 New York State hospital discharge data from the Statewide Planning and Research Cooperative System. Relative risks were computed in multivariable analyses using generalized estimating equations for both studies.;Readmission risks were higher across the top 10 diagnosis-related groups (DRGs) for patients with diabetes regardless of their reason for admission. A total of 1,546,269 discharges were included in the study, of which 18% of patients with diabetes experienced one or more readmissions compared to 11% of patients without diabetes. Risk factors included the patient being discharged to a setting other than home, Charlson co-morbidity score, and payer.;A total of 66,231 discharges were included in the abdominal surgery study. Of those, 9,432 (14%) patients visited an ED within 30 days and 6,048 (9%) patients were readmitted. Risk factors for both outcomes included race, age, Charlson co-morbidity score, length of stay, payer, discharge destination, and hospital bed size. Females had a lower readmission risk. The most common reason for ED visits and readmission were pain and treatment of infections, respectively.;Identification of key contributors to readmission can inform quality improvement strategies for post-surgical acute care. Our findings suggest that the hospitalization is an opportunity to optimize the diabetes treatment regimen by focusing on medication reconciliation, discharge planning and effective communication between providers and caregivers.
机译：在住院后的30天内，将近五分之一的Medicare受益人被重新接纳。再次入院会导致医疗保健成本的上升，并且可以替代整体住院患者的护理质量。对改善护理协调策略的效力感兴趣的政策制定者和付款人已经仔细审查了再入院率，但是这种分析弥补了文献中仍然存在的一些空白。首先，糖尿病患病率上升可能是再次入院的原因。其次，许多腹部手术患者需要术后护理，但是这些手术的护理点和所需的护理水平尚未得到很好的描述。进行了两项回顾性分析：1）有或没有患病的患者30天再入院糖尿病，以及2）接受腹部手术的患者30天再入院和急诊科（ED）。该研究利用了全州计划与研究合作系统的2008-2010年纽约州医院出院数据。两项研究均使用广义估计方程在多变量分析中计算了相对风险。糖尿病患者的前10个诊断相关组（DRG）的再入院风险较高，无论其入院原因如何。该研究总共包括了1,546,269例出院，其中18％的糖尿病患者经历了一次或多次再入院，而11％的非糖尿病患者则再次入院。危险因素包括患者出院以外的其他地方，Charlson合并症评分和付款人。腹部手术研究中总共有66,231次出院。在这些患者中，有9,432名（14％）患者在30天内就诊了ED，并且有6,048名（9％）患者重新入院。两种结果的风险因素包括种族，年龄，查尔森合并症评分，住院时间，付款人，出院目的地和病床大小。女性的再入院风险较低。急诊就诊和再次入院的最常见原因分别是疼痛和感染的治疗。确定再次入院的关键因素可以为术后急性护理的质量改善策略提供依据。我们的发现表明，住院治疗是通过专注于药物和解，出院计划以及医疗服务提供者与护理人员之间的有效沟通来优化糖尿病治疗方案的机会。

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  • 作者

    Mathis, Andrea Fischer.;

  • 作者单位

    State University of New York at Albany.;

  • 授予单位 State University of New York at Albany.;
  • 学科 Health Sciences Epidemiology.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2013
  • 页码 145 p.
  • 总页数 145
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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