背景:减少再入院计划(HRRP)旨在减少急性心肌梗死(AMI)的再入院人数,慢性阻塞性肺疾病(COPD),心力衰竭(HF),肺炎(PNA),冠状动脉旁路移植术(CABG),选择性全髋关节置换术(THA)和全膝关节置换术。
目的:分析HRRP对2010年至2019年再入院率的影响,以及再入院时间如何影响结局。
方法:基于人群的回顾性研究。
方法:2010年至2019年美国国家再入院数据库中的所有患者。
方法:我们记录了人口统计学和临床变量。
方法:使用线性回归模型,我们分析了再入院状态和时间与死亡和住院时间(LOS)结局之间的关联.我们将LOS和费用转换为对数LOS和对数费用,以使数据正常化。
结果:研究中纳入了31553363条记录。其中,4593228(14.55%)在30天内再次入院。从2010年到2019年,COPD的再入院率(20.8%-19.8%),HF(24.9%-21.9%),PNA(16.4%-15.1%),AMI(15.6%-12.9%)和TKR(4.1%-3.4%)降低,CABG(10.2%-10.6%)和THA(4.2%-5.8%)升高。再次入院的患者死亡率较高(6%vs2.8%),LOS较高(3(2-5)vs4(3-7))。10天内再入院的患者死亡率比11-20天(5.4%)和21-30天(4.6%)再入院的患者高6.4%。从出院到再入院的时间增加与死亡率降低相关,比如LOS.
结论:在过去的10年里,除CABG和THA外,HRRP中大多数情况下的再入院率都有所下降。出院后不久再次入院的患者死亡风险较高。
BACKGROUND: The Hospital Readmission Reduction Programme (HRRP) was created to decrease the number of hospital readmissions for acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia (PNA), coronary artery bypass graft (CABG), elective total hip arthroplasty (THA) and total knee arthroplasty.
OBJECTIVE: To analyse the impact of the HRRP on readmission rates from 2010 to 2019 and how time to readmission impacted outcomes.
METHODS: Population-based retrospective study.
METHODS: All patients included in the US National Readmission database from 2010 to 2019.
METHODS: We recorded demographic and clinical variables.
METHODS: Using linear regression models, we analysed the association between readmission status and timing with death and length of stay (LOS) outcomes. We transformed LOS and charges into log-LOS and log-charges to normalise the data.
RESULTS: There were 31 553 363 records included in the study. Of those, 4 593 228 (14.55%) were readmitted within 30 days. From 2010 to 2019, readmission rates for COPD (20.8%-19.8%), HF (24.9%-21.9%), PNA (16.4%-15.1%), AMI (15.6%-12.9%) and TKR (4.1%-3.4%) decreased whereas CABG (10.2%-10.6%) and THA (4.2%-5.8%) increased. Readmitted patients were at higher risk of mortality (6% vs 2.8%) and had higher LOS (3 (2-5) vs 4 (3-7)). Patients readmitted within 10 days had a mortality 6.4% higher than those readmitted in 11-20 days (5.4%) and 21-30 days (4.6%). Increased time from discharge to readmission was associated with a lower likelihood of mortality, like LOS.
CONCLUSIONS: Over the last 10 years, readmission rates decreased for most conditions included in the HRRP except CABG and THA. Patients readmitted shortly after discharge were at higher risk of death.