十四天內非計畫性再入院原因初探

Causes of Unplanned Readmission within 14 Days－－A Preliminary Study

十四天內非計劃性再住院率為醫療品質監測指標中結果面的指標之一。本研究針對某區域醫院自1999年一月一日至十二月三十一日一年期間，400位十四天內非計劃性再住院病患進行統計分析。整體再住院率為3.4%，病患再住院原因中最常見者為疾病因素(63.25%)以及新發生之疾病診斷(28.5%)；研究結果亦發現男性(56.5%)及大於65歲之年長者(48.25%)較易發生再住院；再住院者中以肝膽疾病(12%)、慢性肺部疾病(11.25%)及泌尿道疾病(10%)較多；在所有住院案例中，依ICD-9診斷碼歸類後，相對於整體住院案例，十四天內非計劃性再住院病患以治療的併發症及惡性腫瘤兩者之再入院率為最高。在建立對病人再住院原因的了解後，未來可利用電腦資訊工具建構自動化的監測系統，協助醫師對相關病患之處置更為迅速而嚴謹，進而降低病人再住院率及相關醫療支出。

The rate of readmission to the hospital within 14 days after previous discharge is an indicator of a hospital's health care quality. We retrospectively studied 400 unplanned readmissions occurring within 14 days of index discharge over a one-year period from 1 January to 31 December 1999. Our readmission rate for all admissions was 3.4%. The most common causes for patients' readmitted to the hospital were disease factors (63.25%) and unrelated new diagnoses (28.5%). We also found males (56.5%) and the elderly (≥65 years old, 48.25%) were prone to readmission. The three leading diagnosis accounting for readmission were hepatobiliary and pancreatic diseases (12%), chronic lung disease (11.25%) and urinary tract disease (10%). In addition, the two most prominent ICD-9 code categories of unplanned readmissions that distinguished from all admissions were treatment complications and neoplasm. Having an established readmission baseline, we should create a computerized automatic alert monitoring system to assist physicians. The system would alert them to the need for a more cautious or efficient approach in their medical practice as well as reducing readmission rates and inpatients' expenditures during admission.