| Objective1.The current study intends to understand the prevalence of,the reasons for and the medical costs of hospital readmission of insured patients in Tianjin.2.Aiming to assess the temporal pattern,risk factors and variations for all-cause readmission among hospitalized patients with diabetes in Tianjin,China from 2008 to 2013.3.Aiming to assess the frequency and temporal pattern of and risk factors for all-cause readmission among hospitalized diabetic patients in Tianjin China.Method1.The current study use the Tianjin Basic Medical Insurance Register System(TBMIRS)dataset,retrospectively analyzed the readmission rates at 0-7,8-30,31-60,61-90.>90 intervals for urban employees and rural residents in Tianjin.The patients’ demographic characteristics,the clinical characteristics and case mix for Elixhauser scheme,and the characteristics of the hospitals were considered.The predicted readmission rates were compared between years,and the effect facts of readmission in each interval and the corresponding medical costs were also identified.2.The TBMIRS database was used to identify the discharged patients with diabetes in 2008 to 2013.The influence factors and trends of rehospitalization were analyzed for 7,30,60,90,>90 days predicated readmission rates.The Blinder-Oaxaca decomposition was used to explain the readmission variations between 2008 and 2013.3.The retrospective,cohort analysis used the TBMIRS data of 2011.The differences of readmission-free survival(RFS)between the newly and previously diagnosed patients were compared.Time-dependent Cox models were established to identify the risk factors for readmission at different time-intervals after discharge.Results1.The proportion of readmission patients were 28% from year 2008 to 2013.The readmission rates were highest for patients suffered from psychosis(79.13%)followed by diabetes(30.58%),arrhythmia(28.84%)and cancer(28.01%).The risk factor for one-year readmission rates were admitted to the secondary(OR:1.17[1.15-1.18],p<0.001)and tertiary hospitals(OR:1.26 [1.25-1.28],p<0.001),the length of stay(OR:1.01 [1.01-1.07],p<0.001),being the urban employee(OR:1.09 [1.09-1.10],p<0.001),suffered from AIDS(OR:2.65 [2.17-3.25],p<0.001),lymphoma(OR:1.43[1.36-1.50],p<0.001),metastatic cancer(OR:1.71 [1.59-1.85],p<0.001),liver disease(OR:1.53 [1.47-1.59],p<0.001),solid cancer without metastasis(OR:1.04 [1.00-1.09],p=0.04)and psychosis(OR:5.61 [5.51-5.71],p<0.001).The total medical costs were increased from 127,884 at 2008 to 368,255 at 2013,and the medical costs for 31-60 intervals were higher than others,and distributed skewely.2.The long stay-time at the index hospitalization is a shared risk factor for readmission at 7,30,60,90,>90-day at each year.The >90-day predicted readmission rates were the highest at each year(all p<0.001).The adjusted readmission rates were generally decreased by year(all p<0.001),except for at >90-day interval,in which the decrease occurred from 2010 and slightly increased at 2013(from 7.47% at 2012 to 7.65% at 2013).If the patients had been readmitted in hospital at 2013,then the readmission rates would decreased by 0.29%,0.58%,0.14%,0.13% and 0.18% at 7,30,60,90,>90 day respectively.3.Readmission rates were approximately 30% with the most common diagnoses of cerebral infarction(for Type I diabetes)or diabetes(for Type II diabetes)for patients with diabetes.Approximately 37.2% and 42.8% of readmitted patients with Type I and Type II diabetes were diagnosed previously,and the RFS rates for previously diagnosed patients were significantly lower than for newly diagnosed patients at any time-interval after discharge.Conclusion1.The predicted readmission rates were the highest at 8-30 intervals and the lowest at >90 intervals.In general,more attentions need to put on the 31-60 day readmission.2.To include the specific variables for single diagnose readmission was crucial.Different from the all-cause readmission,the impact factors and readmission rates were the hightest at the>90 interval,followed by at the 30 and 60-day intervals.The stay-time at the index hospitalization was the shared impact factor for readmissions at every interval.The blood glucose condition was associated with the short-term readmission,and hospital-related factors might have impact on the long-term readmission after the discharge.Finding targeted factors for the decreases of readmission rates may have help to control the readmission,in particular the long-interval ones.3.Almost all patients were redmitted at >90 intervals followed by 30 day interval.The CI and diabetes were the most frequent diagnoses for readmitted patients.The previous diagnosed diabetes was a risk factor for RFS from 2008 to 2013. |
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