The crucial factor of hospital readmissions: a retrospective cohort study of patients evaluated in the emergency department and admitted to the department of medicine of a general hospital in Italy

详细信息    查看全文

• 作者：Fabio Fabbian (1) (2)
  Arrigo Boccafogli (1) (2)
  Alfredo De Giorgi (1) (2)
  Marco Pala (1) (2)
  Raffaella Salmi (3)
  Roberto Melandri (4)
  Massimo Gallerani (5)
  Andrea Gardini (6)
  Gabriele Rinaldi (7)
  Roberto Manfredini (1) (2)
  
  1. Clinica Medica ; Department of Medical Science ; University of Ferrara ; 44124 ; Cona Ferrara ; Italy
  2. Department of Medicine ; Azienda Ospedaliera-Universitaria (AOU) of Ferrara ; 44124 ; Cona Ferrara ; Italy
  3. 2nd Unit of Internal Medicine ; Department of Medicine ; AOU of Ferrara ; Ferrara ; Italy
  4. Emergency Department ; AOU of Ferrara ; Ferrara ; Italy
  5. 1st Unit of Internal Medicine ; Department of Medicine ; AOU of Ferrara ; Ferrara ; Italy
  6. Medical Director ; AOU of Ferrara ; Ferrara ; Italy
  7. General Manager ; AOU of Ferrara ; Ferrara ; Italy
  
• 关键词：Hospitalization ; Readmission ; Length of stay ; Mortality ; Comorbidity ; Internal medicine
• 刊名：European Journal of Medical Research
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：20
• 期：1
• 全文大小：382 KB
• 参考文献：1. McKinney M. Preparing for impact. Many hospitals will struggle to escape or absorb penalty for readmissions. Mod Healthc. 2012;42:6鈥?.
  2. Joynt KE, Jha AK. A path forward on Medicare readmissions. N Engl J Med. 2013;368:1175鈥?. CrossRef
  3. http://servizissiir.regione.emilia-romagna.it/deliberegiunta/servlet/AdapterHTTP?action_name=ACTIONRICERCADELIBERE&operation=downloadTestoPdf&codProtocollo=OSP/00/4557.
  4. Joynt KE, Jha AK. Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program. JAMA. 2013;309:342鈥?. CrossRef
  5. Orzag PR, Emmanueel EJ. Health care reform and cost control. N Engl J Med. 2010;363:601鈥?. CrossRef
  6. Bisharat N, Handler C, Schwartz N. Readmissions to medical wards: analysis of demographic and socio-medical factors. Eur J Intern Med. 2012;23:457鈥?0. CrossRef
  7. Vashi AA, Fox JP, Carr BG, D鈥橭nofrio G, Pines JM, Ross JS, et al. Use of hospital-based acute care among patients recently discharged from the hospital. JAMA. 2013;309:364鈥?1. CrossRef
  8. Moran J, Colbert CY, Song J, Hull J, Rajan S, Varghees S, et al. Residents examine factors associated with 30-day. same-cause hospital readmissions on an internal medicine service. Am J Med Qual. 2013;28:492鈥?01. CrossRef
  9. Donz茅 J, Lipsitz S, Bates DW, Schnipper JL. Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study. BMJ. 2013;347:f7171. CrossRef
  10. Ashton CM, Wray NP. A conceptual framework for the study of early readmission as an indicator of quality of care. Soc Sci Med. 1996;43:1533鈥?1. CrossRef
  11. Rising KL, White LF, Fernandez WG, Boutwell AE. Emergency department visits after hospital discharge: a missing part of the equation. Ann Emerg Med. 2013;62:145鈥?0. CrossRef
  12. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309:355鈥?3. CrossRef
  13. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, et al. Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions. BMJ. 2013;347:f6571. CrossRef
  14. Ross JS, Mulvey GK, Stauffer B, Patlolla V, Bernheim SM, Keenan PS, et al. Statistical models and patient predictors of readmission for heart failure: a systematic review. Arch Intern Med. 2008;168:1371鈥?6. CrossRef
  15. Moloney ED, Bennett K, Silke B. Patient and disease profile of emergency medical readmissions to an Irish teaching hospital. Postgrad Med J. 2004;80:470鈥?. CrossRef
  16. Kaboli PJ, Go JT, Hockenberry J, Glasgow JM, Johnson SR, Rosenthal GE, et al. Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals. Ann Intern Med. 2012;157:837鈥?5. CrossRef
  17. Dobrzanska L, Newell R. Readmissions: a primary care examination of reasons for readmission of older people and possible readmission risk factors. J Clin Nurs. 2006;15:599鈥?06. CrossRef
  18. Maurer PP, Ballmer PE. Hospital readmissions鈥揳re they predictable and avoidable? Swiss Med Wkly. 2004;134:606鈥?1.
  19. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418鈥?8. CrossRef
  20. Hasan O, Meltzer DO, Shaykevich SA, Bell CM, Kaboli PJ, Auerbach AD, et al. Hospital readmission in general medicine patients: a prediction model. J Gen Intern Med. 2010;25:211鈥?. CrossRef
  21. Glynn N, Bennett K, Silke B. Emergency medical readmission: long-term trends and impact on mortality. Clin Med. 2011;11:114鈥?. CrossRef
  22. Jones J. Re-admission rate. The price of early discharge. Health Serv J. 1986;96:825.
  23. Marcum ZA, Fried LF. Aging and antihypertensive medication-related complications in the chronic kidney disease patient. Curr Opin Nephrol Hypertens. 2011;20:449鈥?6. CrossRef
  24. Valent F, Clagnan E, Zanier L. Individual and health care factors, and one-year hospital readmission of elderly patients in Friuli Venezia Giulia, Northeastern Italy. Epidemiol Prev. 2012;36:273鈥?.
  25. Salvi F, Morichi V, Grilli A, Spazzafumo L, Giorgi R, Polonara S, et al. Predictive validity of the Identification of Seniors At Risk (ISAR) screening tool in elderly patients presenting to two Italian Emergency Departments. Aging Clin Exp Res. 2009;21:69鈥?5. CrossRef
  26. Yam CH, Wong EL, Chan FW, Leung MC, Wong FY, Cheung AW, et al. Avoidable readmission in Hong Kong-system, clinician, patient or social factor? BMC Health Serv Res. 2010;10:311. CrossRef
  
• 刊物主题：Medicine/Public Health, general;
• 出版者：BioMed Central
• ISSN：2047-783X

文摘

Background Early hospital readmissions, defined as rehospitalization within 30 days from a previous discharge, represent an economic and social burden for public health management. As data about early readmission in Italy are scarce, we aimed to relate the phenomenon of 30-day readmission to factors identified at the time of emergency department (ED) visits in subjects admitted to medical wards of a general hospital in Italy. Methods We performed a retrospective 30-month observational study, evaluating all patients admitted to the Department of Medicine of the Hospital of Ferrara, Italy. Our study compared early and late readmission: patients were evaluated on the basis of the ED admission diagnosis and classified differently on the basis of a concordant or discordant readmission diagnosis in respect to the diagnosis of a first hospitalization. Results Out of 13,237 patients admitted during the study period, 3,631 (27.4%) were readmitted; of those, 656 were 30-day rehospitalizations (5% of total admissions). Early rehospitalization occurred 12 days (median) later than previous discharge. The most frequent causes of rehospitalization were cardiovascular disease (CVD) in 29.3% and pulmonary disease (PD) in 29.7% of cases. Patients admitted with the same diagnosis were younger, had lower length of stay (LOS) and higher prevalence of CVD, PD and cancer. Age, CVD and PD were independently associated with 30-day readmission with concordant diagnosis and kidney disease with 30-day rehospitalization with a discordant diagnosis. Conclusions Comorbid patients are at higher risk for 30-day readmission. Reduction of LOS, especially in elderly subjects, could increase early rehospitalization rates.