Readmissões entre os idosos nos hospitais públicos em Portugal Continental

Trabalho Final do Curso de Especialização em Administração HospitalarRESUMO - Contexto: O presente trabalho teve como objetivo analisar as readmissões ao internamento até 30 dias após a alta nos idosos que tiveram alta dos hospitais públicos portugueses, no ano 2013 e identificar quais os fatores que representam um risco acrescido para a ocorrência de uma readmissão ao internamento. Metodologia: Para responder aos objetivos propostos, recorreu-se à Base de Dados da ACSS do ano 2013, onde constavam todos os episódios de internamento com alta viva dos hospitais públicos de Portugal Continental. Após a utilização do Disease Staging, selecionaram-se para estudo as doenças principais CVS11 – Doença arterial coronária s/ revascularização coronária prévia,CVS13 - Hipertensão Essencial, GUS10 – Infeções do Trato Urinário, NEU04 – Doença Cerebrovascular e RES15 – Pneumonia Bacteriana. Para identificar quais os fatores que estão na base da ocorrência de uma readmissão ao internamento e para apurar qual o efeito da idade nesses fatores, utilizaram-se duas abordagens: a análise descritiva dos dados e a análise estatística, com recurso ao teste não paramétrico de Kruskal-Wallis e ao cálculo do Odds Ratio. Resultados: Dos 99096 episódios de internamento analisados no período em estudo, 9,82% corresponderam a readmissões ao internamento. Dentro destas apurou-se que os idosos têm taxas de readmissão superiores (11,61%) quando comparados com a população não idosa (4,45%). As principais causas de readmissão ao internamento foram as readmissões por complicações pós procedimento, as readmissões por pneumonia e as readmissões por desidratação. A idade, a doença principal, as comorbilidades associadas, com ênfase para aquelas que têm maior carga de doença enquanto doenças principais, a admissão urgente, uma duração de internamento superior a 11 dias, a gravidade elevada do próprio doente e a presença e o tipo de complicações de cuidados são os fatores que se afiguram como representando um risco acrescido para a ocorrência de uma readmissão ao internamento. A influência da idade nestes fatores configura um risco de readmissão muito superior para os idosos no geral e depois na análise por grupos de idosos, para os idosos com idades acima de 75 anos de idade. Conclusão: Em termos gerais, os resultados encontrados são consistentes com a literatura consultada, concluindo-se que, o conhecimento dos fatores de risco para a ocorrência de uma readmissão ao internamento, poderá ser o ponto de partida para a implementação de estratégias que visem a sua redução. Abstract Background: This study aimed to analyze readmissions to hospital within 30 days after discharge in elderly patients who were discharged from the Portuguese Public Hospitals in the year 2013 and identify the factors that pose a risk to the occurrence of a readmission to the hospital. Methods: To meet the proposed objectives, appealed to the ACSS database of discharge summaries of 2013, which contained all inpatients episodes with high living of public hospitals of Portugal. After using the Disease Staging, selected to study major diseases CVS11 - Coronary Artery Disease without previous coronary revascularization, CVS13 - Essential Hypertension, GUS10 – Urinary Tract Infections, NEU04 - Cerebrovascular Disease and RES15 - Bacterial Pneumonia. To identify what factors underlie the occurrence of a readmission to the hospital and to determine what the effect of age on these factors, we used two approaches: a descriptive analysis of the data and statistical analysis, using the nonparametric test Kruskal-Wallis and the calculation of Odds Ratios. Results: Of the 99096 episodes of hospitalization analyzed during the study period, 9.82% were readmitted to the hospital. Within these it was found that the elderly have higher readmission rates (11.61%) compared with the non-elderly population (4.45%). The main causes of hospital readmission were the readmissions for post procedure complications, pneumonia readmissions and readmissions by dehydration. The age, major disease, associated comorbidities, with emphasis on those having highest burden of disease as major diseases, urgently admitted, a period of higher hospitalization within 11 days, the high severity of the patient himself and the presence and type care complications are the factors that seem to represent an increased risk for the occurrence of a readmission to the hospital. The influence of age on these factors sets a much higher risk of readmission for the elderly in general and then in the analysis by elderly groups for the elderly above 75 years old. Conclusion: Overall,ABSTRACT - Background: This study aimed to analyze readmissions to hospital within 30 days after discharge in elderly patients who were discharged from the Portuguese Public Hospitals in the year 2013 and identify the factors that pose a risk to the occurrence of a readmission to the hospital. Methods: To meet the proposed objectives, appealed to the ACSS database of discharge summaries of 2013, which contained all inpatients episodes with high living of public hospitals of Portugal. After using the Disease Staging, selected to study major diseases CVS11 - Coronary Artery Disease without previous coronary revascularization, CVS13 - Essential Hypertension, GUS10 – Urinary Tract Infections, NEU04 - Cerebrovascular Disease and RES15 - Bacterial Pneumonia. To identify what factors underlie the occurrence of a readmission to the hospital and to determine what the effect of age on these factors, we used two approaches: a descriptive analysis of the data and statistical analysis, using the nonparametric test Kruskal-Wallis and the calculation of Odds Ratios. Results: Of the 99096 episodes of hospitalization analyzed during the study period, 9.82% were readmitted to the hospital. Within these it was found that the elderly have higher readmission rates (11.61%) compared with the non-elderly population (4.45%). The main causes of hospital readmission were the readmissions for post procedure complications, pneumonia readmissions and readmissions by dehydration. The age, major disease, associated comorbidities, with emphasis on those having highest burden of disease as major diseases, urgently admitted, a period of higher hospitalization within 11 days, the high severity of the patient himself and the presence and type care complications are the factors that seem to represent an increased risk for the occurrence of a readmission to the hospital. The influence of age on these factors sets a much higher risk of readmission for the elderly in general and then in the analysis by elderly groups for the elderly above 75 years old. Conclusion: Overall, the results are consistent with the literature, concluding that the knowledge of risk factors for the occurrence of a readmission to the hospital may be the starting point for implementing strategies to reduce it.N/