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[BMJ圣诞特刊2018]:12月节日期间出院后死亡或再次入院:队列研究
2019年01月04日 时讯速递, 进展交流 暂无评论

Research Christmas 2018: Heart of the Matter

Death and readmissions after hospital discharge during the December holiday period: cohort study

Lauren Lapointe-Shaw, Peter C Austin, Noah M Ivers, et al.

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4481 (Published 10 December 2018)

Cite this as: BMJ 2018;363:k4481

Abstract

Objective 目的

To determine whether patients discharged from hospital during the December holiday period have fewer outpatient follow-ups and higher rates of death or readmission than patients discharged at other times.

确定与其他时间出院的患者相比,12月节日期间出院回家的患者是否门诊随访较少且死亡或再入院比例增加。

Design 设计

Population based retrospective cohort study.

基于人群的回顾性队列研究

Setting 场景

Acute care hospitals in Ontario, Canada, 1 April 2002 to 31 January 2016.

2002年4月1日至2016年1月31日期间,加拿大安大略省的急性病医院

Participants 研究人群

217 305 children and adults discharged home after an urgent admission, during the two week December holiday period, compared with 453 641 children and adults discharged during two control periods in late November and January.

在12月为期2周的节日期间出院回家的217 305名儿童与成年急诊入院患者,与11月末及1月2个对照阶段出院回家的453 641名儿童与成年患者进行比较。

Main outcome measures 主要预后终点

The primary outcome was death or readmission, defined as a visit to an emergency department or urgent rehospitalisation, within 30 days. Secondary outcomes were death or readmission and outpatient follow-up with a physician within seven and 14 days after discharge. Multivariable logistic regression with generalised estimating equations was used to adjust for characteristics of patients, admissions, and hospital.

主要预后终点为30天内死亡或再次入院(定义为到急诊科就诊或急诊再次入院)。次要预后终点包括出院7天及14天内死亡或再次入院,以及门诊随访情况。采用广义估计方程进行多因素logistic回归对患者特征、入院情况及不同医院进行校正。

Results 结果

217 305 (32.4%) patients discharged during the holiday period and 453 641 (67.6%) discharged during control periods had similar baseline characteristics and previous healthcare utilisation. Patients who were discharged during the holiday period were less likely to have follow-up with a physician within seven days (36.3% v 47.8%, adjusted odds ratio 0.61, 95% confidence interval 0.60 to 0.62) and 14 days (59.5% v 68.7%, 0.65, 0.64 to 0.66) after discharge. Patients discharged during the holiday period were also at higher risk of 30 day death or readmission (25.9% v 24.7%, 1.09, 1.07 to 1.10). This relative increase was also seen at seven days (13.2% v 11.7%, 1.16, 1.14 to 1.18) and 14 days (18.6% v 17.0%, 1.14, 1.12 to 1.15). Per 100 000 patients, there were 2999 fewer follow-up appointments within 14 days, 26 excess deaths, 188 excess hospital admissions, and 483 excess emergency department visits attributable to hospital discharge during the holiday period.

节日期间出院的217 305 名(32.4%) 患者与对照阶段出院的453 641 名(67.6%)患者基线特征及既往住院就诊情况相似 。节日期间出院患者在出院7天(36.3% v 47.8%,校正后比数比 0.61, 95% 可信区间 0.60 to 0.62)和14天内(59.5% v 68.7%, 0.65, 0.64 to 0.66)较少进行随诊。节日期间出院患者30天死亡或再次入院风险更高(25.9% v 24.7%, 1.09, 1.07 to 1.10)。出院7天(13.2% v 11.7%, 1.16, 1.14 to 1.18) 和14天 (18.6% v 17.0%, 1.14, 1.12 to 1.15)的风险也相似。对于每100 000名患者,14天内门诊随诊预约减少2999次,且增加26例死亡,188例住院,483例急诊就诊与节日期间出院相关。

Conclusions 结论

Patients discharged from hospital during the December holiday period are less likely to have prompt outpatient follow-up and are at higher risk of death or readmission within 30 days.

12月节日期间出院的患者较少接受门诊随诊,且30天内死亡或再次入院的风险更高。

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