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[SCCM 2017年会快讯]:再次收入ICU并不提示医疗质量低
2017年02月09日 时讯速递, 进展交流 暂无评论

ICU Readmissions Do Not Signal Inferior Care

Damian McNamara

January 27, 2017

HONOLULU — Readmission to an intensive care unit is often used as a metric by regulators and agencies to gauge quality of care, but it is not an independent predictor of hospital mortality on its own, results from a large study of critical care outcomes reveal.

医疗管理者及管理机构经常把再次收入ICU作为评价医疗质量的指标,但是,一项有关危重病患者的大样本研究结果显示,再次收入ICU本身并非住院死亡的独立预测因素。

"The factors contributing to patient mortality were the illness of the patient and the age," John Santamaria, MD, intensive care specialist at the University of Melbourne in Australia, told Medscape Medical News. "Therefore, readmission to the ICU as a general indicator of ICU care is inappropriate."

“导致患者死亡的原因包括疾病及年龄,”澳大利亚墨尔本大学的ICU医生John Santamaria对MEDSCAPE医学新闻频道说到。“因此,将再次收入ICU作为反映ICU医疗质量的指标并不合适。”

Dr Santamaria and his colleagues evaluated 10,884 adults consecutively discharged from one of 40 intensive care units in Australia and New Zealand to a hospital ward from October 2009 to February 2010.

Santamaria医生及其同事对2009年10月至2010年2月间澳大利亚和新西兰40个ICU中连续出院的10884名患者进行了评估。

He presented the study results during a hot topics and late-breaking science session here at the Society of Critical Care Medicine 46th Critical Care Congress.

Santamaria医生在美国重症医学会第46届重症医学大会上研究热点及近期发现部分发表了上述研究结果。

Most of the 581 (5.3%) patients readmitted to the ICU "required one more readmission, but a significant number came back multiple times," Dr Santamaria reported. The total number of readmissions was 674.

再次收入ICU的581名(5.3%)患者中,大多数“需要再一次入院,但很多患者入院多次,”Santamaria医生报告。总计再入院次数为674。

Table 1. ICU Readmissions and Hospital Mortality Risk

Although readmissions are associated with increased mortality and an increased length of stay, "readmission per se is not a risk for mortality," Dr Santamaria explained.

尽管再次入院伴随病死率增加,住院日延长,“但是,再次入院本身并非死亡的危险因素,”Santamaria医生解释到。

"The first, second, and third readmissions were all not significant, so, in our view, hospital mortality is much more likely to be associated with patient factors," he said.

“第一次,第二次及第三次再次入院都没有太大影响,因此,我们的观点认为,住院病死率更可能与患者因素相关,”他谈到。

Table 2. Independent Risk Factors Associated With ICU Readmission

"I wasn't surprised by the findings," Dr Santamaria acknowledged. "I always thought that patient factors were the main driver of mortality. One reason to do this study was to provide definitive evidence for this feeling."

“我对这一发现并不感到意外,”Santamaria医生承认。“我总是思考,患者因素才是导致死亡的主要因素。进行此项研究的原因之一是为上述观点提供确切的证据。”

Complete study results were published to coincide with Dr Santamaria's presentation in Critical Care Medicine (2017;45:290-297). In their report, his team notes that after adjustment "for these patient-related factors and for multiple ICU admissions, there was no independent statistical association between readmission to ICU and subsequent hospital mortality."

在Santamaria医生发布上述结果的同时,全部研究结果在Critical Care Medicine杂志发表。在他们的报告中,特别提到,“在针对患者相关因素及多次入住ICU进行校正后,再次收入ICU与住院病死率之间并无独立的统计学相关性。”

These findings "add fuel to the argument that readmission rates should not be viewed as a quality metric," said Timothy Buchman, PhD, MD, from Emory University Hospital in Atlanta.

这些发现“为再次入院率是否应当成为质量评估指标的争论增加了论据,”来自亚特兰大Emory大学的Timothy Buchman医生说到。

This study "confirms that most unplanned readmissions to the ICU are neither predictable nor preventable," he told Medscape Medical News.

这项研究“证实,多数非计划再次收入ICU既无法预测也无法预防,”他对MEDSCAPE医学新闻频道说到。

Although this study was conducted in Australia and New Zealand, patterns are similar in the United States. "Readmissions bedevil and perplex intensive care units worldwide," Dr Buchman said.

尽管这项研究在澳大利亚和新西兰进行,但美国的情况与此相似。“再次入院问题困扰着全世界的ICU,”Buchman医生谈到。

In this study, 84% of the readmissions to the ICU were unplanned, and only 9% were considered preventable. Time to first readmission was significantly shorter for unplanned readmissions than for planned readmissions (3.2 vs 6.9 days; P < .001).

在这项研究中,84%的再次收入ICU病例为非计划性,仅有9%是可以预防的。与计划性再次收入ICU相比,非计划性收入ICU至首次再次收入的时间更短(3.2 vs 6.9 天;P < .001)。

Median patient age was 63 years, 61% of the study population was male, and risk for death on first admission, according to median APACHE III score, was 9%. During the first admission, 56% of patients required mechanical ventilation, 42% needed inotropes, and 5% underwent renal replacement therapy. Overall, 5.2% died before hospital discharge.

患者中位年龄为63岁,61%为男性,根据APACHE III评分中位数,首次收入ICU的死亡风险为9%。在首次收入ICU期间,56%的患者需要机械通气,42%需要强心药物,5%接受肾脏替代治疗。总计5.2%的患者出院前死亡。

Dr Santamaria has disclosed no relevant financial relationships. Dr Buchman is editor-in-chief of Critical Care Medicine, the journal in which the results were published.

Society of Critical Care Medicine (SCCM) 46th Critical Care Congress. Presented January 24, 2017.

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