潜在可预防住院的三个轨迹组成员的关键预测因素是年龄,合并症的数量,慢性阻塞性肺疾病和充血性心力衰竭的存在,以及发生髋部骨折的脆弱风险。他们的轨迹组的这些预测因子可用于靶向预防策略。
目的:尽管老年髋部骨折患者住院后多次再入院的风险更高,对出院后可能可预防的住院(PPH)知之甚少。这项研究检查了老年人髋部骨折后五年内PPH的基于组的轨迹,并确定了预测其轨迹组成员资格的因素。
方法:这项回顾性队列研究使用新南威尔士州的住院率和死亡率数据进行。澳大利亚,2013年至2021年。确定了年龄≥65岁的患者,这些患者在2014年至2016年之间因髋部骨折入院并出院。基于分组的轨迹模型是根据索引住院后随后的PPH的数量得出的。多因素逻辑回归检查了预测轨迹组成员资格的因素。
结果:在17,591例患者中发现了三个PPH轨迹组:无PPH(89.5%),低PPH(10.0%),和高PPH(0.4%)。PPH轨迹组成员身份的关键预测因素是年龄,合并症的数量,痴呆症,慢性阻塞性肺疾病(COPD),充血性心力衰竭(CHF),脆弱的风险,事故地点,手术,康复,和住院时间。高PPH患者合并≥2合并症(OR:1.86,95%置信区间(CI):1.04-3.32)和COPD(OR:2.97,95CIs:1.76-5.04)的比例高于无PPH,与没有PPH的患者相比,低PPH和高PPH患者更可能有CHF和高虚弱风险以及≥2合并症和COPD。
结论:确定髋部骨折后PPH的轨迹和预测轨迹组成员关系的因素可用于减少多次再入院的目标策略。
Key predictors of three trajectory group membership of potentially preventable hospitalisations were age, the number of comorbidities, the presence of chronic obstructive pulmonary disease and congestive heart failure, and frailty risk at the occurrence of hip fracture. These predictors of their trajectory group could be used in targeting prevention strategies.
OBJECTIVE: Although older adults with hip fracture have a higher risk of multiple readmissions after index hospitalisation, little is known about potentially preventable hospitalisations (PPH) after discharge. This study examined group-based trajectories of PPH during a five-year period after a hip fracture among older adults and identified factors predictive of their trajectory group membership.
METHODS: This retrospective cohort study was conducted using linked hospitalisation and mortality data in New South Wales, Australia, between 2013 and 2021. Patients aged ≥ 65 years who were admitted after a hip fracture and discharged between 2014 and 2016 were identified. Group-based trajectory models were derived based on the number of subsequent PPH following the index hospitalisation. Multinominal logistic regression examined factors predictive of trajectory group membership.
RESULTS: Three PPH trajectory groups were revealed among 17,591 patients: no PPH (89.5%), low PPH (10.0%), and high PPH (0.4%). Key predictors of PPH trajectory group membership were age, number of comorbidities, dementia, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), frailty risk, place of incident, surgery, rehabilitation, and length of hospital stay. The high PPH had a higher proportion of patients with ≥ 2 comorbidities (OR: 1.86, 95% confidence interval (CI): 1.04-3.32) and COPD (OR: 2.97, 95%CIs: 1.76-5.04) than the low PPH, and the low and high PPHs were more likely to have CHF and high frailty risk as well as ≥ 2 comorbidities and COPD than the no PPH.
CONCLUSIONS: Identifying trajectories of PPH after a hip fracture and factors predictive of trajectory group membership could be used to target strategies to reduce multiple readmissions.