Impact of Elderly Acute Care Discharge Services on Prevention of Rehospitalisation: A Retrospective Cohort Study Using National Health Data from Kita Ward, Tokyo.

IF 2.6 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

International Journal of Integrated Care Pub Date : 2025-02-04 eCollection Date: 2025-01-01 DOI:10.5334/ijic.8913

Masumi Takei, Satoshi Miyata, Mariko Inoue, Kenzo Takahashi

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Abstract

Introduction: Integrated care poses a significant challenge for healthcare policies in Japan as evaluation of hospital discharge services is limited. This study aimed to elucidate the effects of discharge services for elderly acute-care patients on preventing rehospitalisation.

Methods: A retrospective cohort study was conducted using national health data from Kita Ward, Tokyo. Survival analysis was performed with a Cox proportional hazards model, with readmission hazard ratios (HRs) as the primary endpoint. Subgroup analysis examined interactions between each discharge service category (dummy variable) and readmission.

Results: The study encompassed 6,681 subjects. The Cox model adjusted for age, gender, and complications revealed increased readmission events in the discharge service group (HR = 2.92, 95% CI 2.60-3.27). Subgroup analysis by age and length of hospital stay identified a preventive effect in the 85-year-old group (HR = 0.68, 95% CI 0.49-0.93) and 15-21-day length of stay group (HR = 0.73, 95% CI 0.53-1.01), suggesting that discharge services may inadvertently lower barriers to readmission due to healthcare system influences.

Conclusion: While discharge services may elevate readmission demand, they appear to have a preventive effect for individuals aged 85 and over or with an average length of stay of 15-21 days.

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老年急症护理出院服务对预防再住院的影响：一项使用东京北区全国健康数据的回顾性队列研究

导言：综合护理对日本的医疗保健政策提出了重大挑战，因为对出院服务的评估有限。本研究旨在探讨老年急症病人出院服务对预防再住院的影响。方法：采用东京北区的全国健康数据进行回顾性队列研究。生存分析采用Cox比例风险模型，以再入院风险比（hr）为主要终点。亚组分析检查了每个出院服务类别（虚拟变量）与再入院之间的相互作用。结果：研究共纳入6681名受试者。经年龄、性别和并发症调整后的Cox模型显示，出院服务组再入院事件增加（HR = 2.92, 95% CI 2.60-3.27）。按年龄和住院时间长短进行的亚组分析发现，85岁组（HR = 0.68, 95% CI 0.49-0.93）和15-21天住院时间组（HR = 0.73, 95% CI 0.53-1.01）具有预防作用，表明由于医疗系统的影响，出院服务可能无意中降低了再入院的障碍。结论：虽然出院服务可能会增加再入院需求，但对于85岁及以上或平均住院时间为15-21天的患者，出院服务似乎具有预防作用。

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

International Journal of Integrated Care HEALTH CARE SCIENCES & SERVICES-

CiteScore

3.80

自引率

8.30%

发文量

887

审稿时长

>12 weeks

期刊介绍： Established in 2000, IJIC’s mission is to promote integrated care as a scientific discipline. IJIC’s primary purpose is to examine critically the policy and practice of integrated care and whether and how this has impacted on quality-of-care, user experiences, and cost-effectiveness. The journal regularly publishes conference supplements and special themed editions. To find out more contact Managing Editor, Susan Royer. The Journal is supported by the International Foundation for Integrated Care (IFIC).