Long-term Trend And Influencing Factors Of Stroke Patients’ Readmission In Tianjin

Objective:The purpose of this study was to control the readmission rate of stroke patients,improve the quality of medical services and reduce medical costs.The following studies were carried out:first,to display the readmission rate of stroke patients from 2003 to 2013.Second,to find the time window with the highest readmission rate of stroke patients;Third,to display the trend of readmission rate of stroke patients in different time Windows.Fourthly,to analysis the factors influencing the readmission rate of stroke patients in different time Windows.Methods:This study was based on the TBMIRS database containing all records of the beneficiaries from January 2003 to 31 December 2013 and 50%records were randomly selected.R language version 3.5.1 was used for data cleaning and statistical analysis in Windows.Using relative numbers to describe the distribution of classify data.The Cochran-Armitage method was used to analyze the change trend of readmission rate in different time window,and theχ~2test was used to analysis the difference of the readmission rate at different time Windows in the same year;the CMHχ~2analysis was executed to compare the readmission rate of patients with different characteristics and stratification variables was year;Binary logistic regression was established to explore the influencing factors of the readmission rate.Random forest(a predictive model)for readmission of stroke patients was established to explore the key factors for predicting readmission rate.The test level isa=0.05with two sides.Results:(1)a total of 139 455 stroke patients aged 42-88 years were included in this study,with an average age of 66.62±10.80,and 89 785 males(64.38%)with66.41±11.06 years old,and 49 670 females(35.62%)with 67.01±10.29 years old.(2)the readmission rate within 30 days,the readmission rate within 61-90 days and the annual readmission rate of stroke patients showed statistical differences,and the readmission rate of these three time Windows showed an upward trend and there was no statistical difference in other trend of readmission time window.There were statistically significant differences in readmission rates of different years through the comparison of different years with four time windows(P<0.001),and the readmission rate of 30 days was significantly higher than that of other time Windows.(3)univariate analysis showed that age,length of stay,gender,hospital grade,retirement and personal payment were influencing factors for annual readmission of stroke patients.Study find,age,length of stay,hospital grade,retirement and personal payment are also influencing factors for readmission within 30 days in stroke patients.(4)After adjusting the impact of the year,the studies showed that gender,length of stay,retirement,hospital grade and age were influencing factors for annual readmitted stroke patients,and length of stay,hospital grade,retirement were influencing factors for readmitted stroke patients within 30 days.(5)logistic regression analysis showed that the annual readmission risk of males was 1.157 times higher than that of females.LOS<10 days was a protective factor for year-round readmission(OR=0.686).Primary and secondary hospitals were protective factors for year-round readmission(OR=0.536,OR=0.232).Multivariate analysis of 30-day readmission found that LOS<10 days was a risk factor for readmission of stroke patients(OR=1.178),and low hospital grade was a protective factor for readmission(OR=0.581,OR=0.694).(6)According to Random forest,hospital category,LOS and payment proportion were important predictor of readmission in patients with stroke,but the model prediction accuracy was only 75.79%,it may be due to some important variable were not included in the model.For example,the severity of disease,the number of patients with complications.Further exploration and research are needed.Conclusion:The readmission of stroke patients is caused by multiple factors,and the factors are independent and interactive.There are positive significances to carry out the research on stroke readmission for medical treatment,management and medical activities.Exploring the influencing factors of stroke readmission could provide reference basis for reducing the personal burden and social pressure.