Factors affecting the unplanned readmissions of elderly patients in a Geriatric medical center

• Main Authors: Chun-Fang Chiu, 邱群芳
• Other Authors: I Lee
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/63002900283767648527

碩士 === 義守大學 === 醫務管理學系 === 103 === Background: Re-hospitalizations for elderly patients are an increasing health care burden, and readmission rates are considered to be an indicator of quality in health care management. Nonetheless, limited information about unplanned re-hospitalizations for the elderly is available in Taiwan. The purpose of this study was to understand the rate of unplanned re-hospitalizations and to identify the related risk factors in a geriatric medical center in Taiwan. Methods: A case-control study was conducted. The elderly patients hospitalized in a geriatric medical center in south Taiwan from January 1st, 2012, to December 31st, 2014 were selected. The eligible cohort of patients was divided into two groups: patients who were readmitted within 90 days (the re-admitted group) and those who admitted but not readmitted within 90 days of discharge (non-readmitted group). All data were analyzed by the SPSS for windows software package. The chi-square tests were used to compare the demographic and clinical data between the two groups, while the multiple logistic regression was used to determine the possible risk factors. Results: All 366 elder people were analyzed. Of them, 264 (72.1%) patients were male, while 102 (27.9%) patients were female. The means of age was 83.1±6.8 years. The first three major diagnoses of admission were general geriatric syndrome (24.3％)、skeletal disease (19.1％) and infection (11.5％). Most patients hospitalized from emergency room (75.4%). The unplanned re-admission within 14 days, 30 days, 60 days and 90 days were 4.9%、9.6%、13.9% and 20.2%, respectively. Compared with the young-old people (65-74 years), the odds ratio of the oldest-old people (≧85 years ) was 0.32 (95%CI：0.14-0.72，P=0.007). The other significant factors that were associated with the unplanned re-admission within 90 days included the pathway of admission (via emergency room , OR=2.45, 95%CI：1.11-5.42，P=0.026）, malignant tumor (OR=2.21, 95%CI：1.09-4.49), heart disease (OR=1.93, 95%CI：1.09-3.41),kidney disease (OR=2.65, 95%CI：1.31-5.33), chronic lung disease (OR=2.18, 95%CI：1.08-4.39) and the lower value of hemoglobin (＜11.5mg/dl , OR=1.91, 95%CI：1.06-3.45). Conclusion: We identify the elder patients who are prone to readmission within 90 days. We suggested that the healthcare providers should aware of these risk factors when caring the elder people. Such high patients may also be allocated to an intervention program that would minimize the rate of readmission and reduce the overall cost of patient care and the burden in health service.