A retrospective cohort study of high-impact users among patients with cerebrovascular conditions

作者：Rao Ahsan^*; Jones Alice; Bottle Alex; Darzi Ara; Aylin Paul

来源：BMJ Open, 2017, 7(6): e014618.

DOI：10.1136/bmjopen-2016-014618

Objective To apply group-based trajectory modelling GBTM) to the hospital administrative data to evaluate, model and visualise trends and changes in the frequency of long-term hospital care use of the subgroups of patients with cerebrovascular conditions.
Design A retrospective cohort study of patients with cerebrovascular conditions.
Settings Secondary care of all patients with cerebrovascular conditions admitted to English National Hospital Service hospitals.
Participants All patients with cerebrovascular conditions identified through national administrative data Hospital Episode Statistics) and subsequent emergency hospital admissions followed up for 4 years.
Main outcome measure Annual number of emergency hospital readmissions.
Results GBTM model classified patients with intracranial haemorrhage n=2605) into five subgroups, whereas ischaemic stroke n=34 208) and transient ischaemic attack TIA) n=20 549) patients were shown to have two conventional groups, low and high impact. The covariates with significant association with high-impact users 17.1%) among ischaemic stroke were epilepsy OR 2.29), previous stroke OR 2.18), anxiety/depression OR 1.63), procedural complication OR 1.43), admission to intensive therapy unit ITU) or high dependency unit HDU) OR 1.42), comorbidity score OR 1.36), urinary tract infections OR 1.32), vision loss OR 1.32), chest infections OR 1.25), living alone OR 1.25), diabetes OR 1.23), socioeconomic index OR 1.20), older age OR 1.03) and prolonged length of stay OR 1.00). The covariates associated with high-impact users among TIA 20.0%) were thromboembolic event OR 3.67), previous stroke OR 2.51), epilepsy OR 2.25), hypotension OR 1.86), anxiety/depression OR 1.63), amnesia OR 1.62), diabetes OR 1.58), anaemia OR 1.55), comorbidity score OR 1.39), atrial fibrillation OR 1.27), living alone OR 1.25), socioeconomic index OR 1.13), older age OR 1.04) and prolonged length of stay OR 1.02). The high-impact users 0.5%) among intracranial haemorrhage were strongly associated with thromboembolic event OR 20.3) and inversely related to older age OR 0.58).
Conclusion GBTM effectively assessed trends in the use of hospital care by the subgroups of patients with cerebrovascular conditions. High-impact users persistently had higher annual readmission during the follow-up period.

• 出版日期2017-6