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Frequency of hospital readmission and care fragmentation in gastroparesis:A nationwide analysis

查看全文 作　　者：Emad [1,2]Qayed;Mayssan [3]Muftah 高影响力作者 机构地区：[1]Department of Medicine,Division of Digestive Diseases,Emory University School of Medicine;[2]Department of Gastroenterology,Grady Memorial Hospital;[3]Department of Medicine,Emory University School of Medicine高影响力机构 出　　处：《World Journal of Gastrointestinal Endoscopy》索引2018年第10卷第9期,共10页高影响力期刊 摘　　要：AIM To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.METHODS We identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database,which captures statewide readmissions.We excluded patients who died during the hospitalization,and calculated 30 and 90-d unplanned readmission and care fragmentation rates.Readmission to a non-index hospital(i.e.,different from the hospital of the index admission) was considered as care fragmentation.A multivariate Cox regression model was used to analyze predictors of 30-d readmissions.Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation.Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission.Mortality during the first readmission,hospitalization cost,length of stay,and rates of 60-d readmission were compared between those with and without care fragmentation.RESULTS There were 30064 admissions with a primary diagnosis of gastroparesis.The rates of 30 and 90-d readmissions were 26.8% and 45.6%,respectively.Younger age,male patient,diabetes,parenteral nutrition,≥ 4 Elixhauser comorbidities,longer hospital stay(> 5 d),large and metropolitan hospital,and Medicaid insurance were associated with increased hazards of 30-d readmissions.Gastric surgery,routine discharge and private insurance were associated with lower 30-d readmissions.The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%,respectively.Younger age,longer hospital stay(> 5 d),self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation.Diabetes,enteral tube placement,parenteral nutrition,large metropolitan hospital,and routine discharge were associated with decreased risk of 30-d fragmentation.Patients who were readmitted to a non-index hospital had longer length of stay(6.5 vs 5.8 d,P = 0.03),and higher mean hospitalization cost($15645 vs $12311,P < 0.0001),compared to those readmitted to the index hospital.There were no differences in mortality(1.0% vs 1.3%,P = 0.84),and 60-d readmission rate(55.3% vs 54.6%,P = 0.99) between the two groups.CONCLUSION Several factors are associated with the high 30-d readmission and care fragmentation in gastroparesis.Knowledge of these predictors can play a role in implementing effective preventive interventions to highrisk patients. 关 键 词：GASTROPARESIS Hospital READMISSION CARE FRAGMENTATION
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