Association between hospital type and length of stay and readmissions for young adults with complex chronic diseases

IF 2.4 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine Pub Date : 2024-10-15 DOI:10.1002/jhm.13524

Jeffrey Lutmer MD, Emily Bucholz MD, PhD, MPH, Katherine A. Auger MD, MSc, Matt Hall PhD, J. Mitchell Harris II PhD, Ashley Jenkins MD, MSc, Rustin Morse MD, Mark I. Neuman MD, MPH, Alon Peltz MD, MBA, MHS, Harold K. Simon MD, MBA, Ronald J. Teufel II MD, MSCR

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引用次数: 0

Abstract

Background

There is a paucity of information around whether hospital length of stay and readmission rates differ based upon hospital type for adolescents and young adults (AYA) with complex chronic diseases (CCDs).

Objective

To measure the association between hospital type and readmission rates and index admission LOS among AYA with CCDs.

Methods

We performed a retrospective cross-sectional study of 2017 Healthcare Cost and Utilization Project State Inpatient Databases, including patients 12–25 years old with cystic fibrosis (CF), sickle cell disease (SCD), spina bifida (SB), inflammatory bowel disease (IBD), and diabetes mellitus (DM). Index hospitalizations were categorized by hospital type (pediatric hospitals [PHs], adult hospitals with pediatric services [AHPSs], and adult hospitals without pediatric services [AHs]), CCD, and age group. We compared case-mix adjusted 30-day readmission rates and differences in index admission LOS between hospital types.

Results

Adult hospitals without pediatric services exhibited higher readmission rates (25.4%) than AHPS (22.9%) and PH (15.1%). Compared to patients with CF admitted to AH, lower readmission rates were associated with longer LOS at both AHPS (relative ratio [RR]: 1.25, 95% confidence interval [CI]: 1.02–1.55) and PH (RR: 1.59, 95% CI: 1.28–1.97). Patients with DM admitted to AHPS (odds ratio [OR]: 0.75, 95% CI: 0.62–0.91) and PH (OR: 0.47, 95% CI: 0.31–0.71) also demonstrated lower readmission rates than those admitted to AH.

Conclusions

For AYA with CCD, hospital type is associated with differences in readmission rates and LOS. Lower readmission rates at hospitals with pediatric services compared to adult hospitals without pediatric services suggest hospital type has a significant impact on outcomes.

Abstract Image

查看原文本刊更多论文

患有复杂慢性病的年轻成年人的医院类型与住院时间和再入院率之间的关系。

背景：关于患有复杂慢性病（CCD）的青少年和年轻成人（AYA）的住院时间和再入院率是否因医院类型而异的信息很少：关于患有复杂慢性病（CCD）的青少年和年轻成人（AYA）的住院时间和再入院率是否因医院类型而异的信息很少：测量患有复杂慢性病的青少年和年轻成人的医院类型与再入院率和指标入院时间之间的关联：我们对2017年医疗成本与利用项目州住院患者数据库进行了一项回顾性横断面研究，其中包括12-25岁患有囊性纤维化（CF）、镰状细胞病（SCD）、脊柱裂（SB）、炎症性肠病（IBD）和糖尿病（DM）的患者。指数住院按医院类型（儿科医院[PHs]、提供儿科服务的成人医院[AHPSs]和不提供儿科服务的成人医院[AHs]）、CCD 和年龄组进行分类。我们比较了不同类型医院的病例组合调整后 30 天再入院率和指标入院 LOS 的差异：没有儿科服务的成人医院的再入院率（25.4%）高于AHPS（22.9%）和PH（15.1%）。与入住AH的CF患者相比，入住AHPS（相对比[RR]：1.25，95%置信区间[CI]：1.02-1.55）和PH（RR：1.59，95%置信区间[CI]：1.28-1.97）的再入院率较低，但住院时间较长。入住AHPS（几率比[OR]：0.75，95% CI：0.62-0.91）和PH（OR：0.47，95% CI：0.31-0.71）的DM患者的再入院率也低于入住AH的患者：结论：对于患有慢性阻塞性肺病的亚健康患者而言，医院类型与再入院率和住院时间的差异有关。与不提供儿科服务的成人医院相比，提供儿科服务的医院再入院率更低，这表明医院类型对治疗效果有显著影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.