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Abstract：
BACKGROUND: Reducing hospital readmissions, including preventable healthcare-associated infections, is a national priority. The proportion of readmissions due to infections is not well-understood. Better understanding of hospital risk factors for readmissions and infection-related readmissions may help optimize interventions to prevent readmissions.
METHODS: Retrospective cohort study of California acute care hospitals and their patient populations discharged between 2009 and 2011. Demographics, comorbidities, and socioeconomic status were entered into a hierarchical generalized linear mixed model predicting all-cause and infection-related readmissions. Crude verses adjusted hospital rankings were compared using Cohen\'s kappa.
RESULTS: We assessed 30-day readmission rates from 323 hospitals, accounting for 213 879 194 post-discharge person-days of follow-up. Infection-related readmissions represented 28% of all readmissions and were associated with discharging a high proportion of patients to skilled nursing facilities. Hospitals serving populations with high proportions of males, comorbidities, prolonged length of stay, and populations living in a federal poverty area, had higher all-cause and infection-related readmission rates. Academic hospitals had higher all-cause and infection-related readmission rates (odds ratio 1.24 and 1.15, respectively). When comparing adjusted vs crude hospital rankings for infection-related readmission rates, adjustment revealed 31% of hospitals changed performance category for infection-related readmissions.
CONCLUSIONS: Infection-related readmissions accounted for nearly 30% of all-cause readmissions. High hospital infection-related readmissions were associated with serving a high proportion of patients with comorbidities, long lengths of stay, discharge to skilled nursing facility, and those living in federal poverty areas. Preventability of these infections needs to be assessed.
METHODS: Retrospective cohort study of California acute care hospitals and their patient populations discharged between 2009 and 2011. Demographics, comorbidities, and socioeconomic status were entered into a hierarchical generalized linear mixed model predicting all-cause and infection-related readmissions. Crude verses adjusted hospital rankings were compared using Cohen\'s kappa.
RESULTS: We assessed 30-day readmission rates from 323 hospitals, accounting for 213 879 194 post-discharge person-days of follow-up. Infection-related readmissions represented 28% of all readmissions and were associated with discharging a high proportion of patients to skilled nursing facilities. Hospitals serving populations with high proportions of males, comorbidities, prolonged length of stay, and populations living in a federal poverty area, had higher all-cause and infection-related readmission rates. Academic hospitals had higher all-cause and infection-related readmission rates (odds ratio 1.24 and 1.15, respectively). When comparing adjusted vs crude hospital rankings for infection-related readmission rates, adjustment revealed 31% of hospitals changed performance category for infection-related readmissions.
CONCLUSIONS: Infection-related readmissions accounted for nearly 30% of all-cause readmissions. High hospital infection-related readmissions were associated with serving a high proportion of patients with comorbidities, long lengths of stay, discharge to skilled nursing facility, and those living in federal poverty areas. Preventability of these infections needs to be assessed.
摘要：
背景：减少再入院，包括可预防的医疗保健相关感染，是国家的优先事项。由于感染而再次入院的比例还没有得到很好的理解。更好地了解再入院和感染相关再入院的危险因素可能有助于优化干预措施以预防再入院。
方法：对2009年至2011年间加州急症护理医院及其出院患者人群进行回顾性队列研究。人口统计,合并症,和社会经济状况被输入到分层广义线性混合模型中，预测全因和感染相关的再入院。使用科恩的kappa比较了粗略的经过调整的医院排名。
结果：我们评估了323家医院的30天再入院率，占213879194人出院后随访日。与感染相关的再入院占所有再入院的28％，并且与将高比例的患者送往熟练的护理机构有关。为男性比例高的医院服务，合并症,延长逗留时间，生活在联邦贫困地区的人口，全因和感染相关的再入院率较高。学术医院的全因和感染相关的再入院率较高（比值比分别为1.24和1.15）。当比较与感染相关的再入院率的调整后医院排名与粗略医院排名时，调整结果显示,31%的医院改变了与感染相关的再入院表现类别.
结论：感染相关的再入院占全因再入院的近30%。高医院感染相关的再入院与服务高比例的合并症患者相关。长时间逗留，出院到熟练的护理机构，以及那些生活在联邦贫困地区的人。需要评估这些感染的可预防性。
方法：对2009年至2011年间加州急症护理医院及其出院患者人群进行回顾性队列研究。人口统计,合并症,和社会经济状况被输入到分层广义线性混合模型中，预测全因和感染相关的再入院。使用科恩的kappa比较了粗略的经过调整的医院排名。
结果：我们评估了323家医院的30天再入院率，占213879194人出院后随访日。与感染相关的再入院占所有再入院的28％，并且与将高比例的患者送往熟练的护理机构有关。为男性比例高的医院服务，合并症,延长逗留时间，生活在联邦贫困地区的人口，全因和感染相关的再入院率较高。学术医院的全因和感染相关的再入院率较高（比值比分别为1.24和1.15）。当比较与感染相关的再入院率的调整后医院排名与粗略医院排名时，调整结果显示,31%的医院改变了与感染相关的再入院表现类别.
结论：感染相关的再入院占全因再入院的近30%。高医院感染相关的再入院与服务高比例的合并症患者相关。长时间逗留，出院到熟练的护理机构，以及那些生活在联邦贫困地区的人。需要评估这些感染的可预防性。
