Objectives: Stroke readmission increases financial burden on the family and the consumption of medical resources, and 30-day readmission rate is an important indicator for quality evaluation on health services. The influential factors for readmission mainly include patient-related factors, hospital factors, and society-related factors, with regional differences. This study aims to explore the spatial distribution and its main relevant factors for 30-day readmission of stroke patients in Hunan Province, and to provide the useful information for the improvement of regional prevention and control of stroke readmission.
Methods: Stroke patients in Hunan Province who were hospitalized in 2018 and readmitted within 30 days were included in the study. The vector map of the county boundary in Hunan Province was used as the basic map since county was the spatial analysis unit. SPSS 26.0 and ArcGIS 10.8 were used for statistical analysis that contains descriptive analysis of the general situation and the distribution map of readmission rate within 30 days of stroke patients. Spatial autocorrelation analysis and spatial regression analysis were further used to find the spatial clusters of the 30-day readmission rate of stroke and the local relationship between the readmission rate and main influential factors.
Results: In 2018, a total of 172 800 stroke patients were hospitalized in Hunan Province, of which 6 953 patients were re-hospitalized within 30 days after discharging due to stroke. The 30-day readmission rate was 4.09% in Hunan Province. The clusters of stroke readmission rates were mainly concentrated in the northeast and western regions in Hunan Province. The geographically weighted regression revealed that proportion of patients with complications, number of hospitals per 10 000 population and number of primary medical and health care institution per 10 000 population were the main relevant factors for stroke readmission, and there were differences both in the direction and degree of the effect on readmission in different regions.
Conclusions: The 30-day readmission rate for stroke patients in Hunan province and its main influential factors had spatial heterogeneity. The key prevention and control areas were mainly concentrated in the northeast and western regions. It is recommended that the prevention and treatment of stroke complications and the construction of medical institutions need to be strengthened to improve the quality of medical services, particularly in the western region. The importance to the treatment of stroke complications should be attached in the northern region, and the primary health care should be reinforced in the northeast region. All counties should take prevention and control measures according to local conditions, so as to effectively control the readmission rate of stroke within 30 days.
目的: 脑卒中再入院增加了家庭的经济负担及医疗资源耗费，且30 d再入院率是评价卫生服务质量的重要指标。再入院的影响因素主要包括患者相关因素、医院因素和社会相关因素等，存在区域差异。本研究旨在了解湖南省各区/县脑卒中患者30 d再入院的空间分布状况及主要影响因素的空间分布异质性，为完善脑卒中再入院的区域化防控措施提供科学依据。方法: 以在2018年住院且30 d再入院的湖南省脑卒中患者为研究对象，以区/县作为空间分析单位，以湖南省县界矢量地图作为基础地图，采用SPSS 26.0对4大区域的一般情况进行描述性分析，ArcGIS 10.8绘制脑卒中患者30 d再入院率分布图，进一步采用空间自相关分析和空间回归分析探索脑卒中30 d再入院率的空间聚集性及再入院率与主要影响因素的局域关系。结果: 2018年，湖南省共有17.28万名脑卒中患者住院治疗，其中6 953名患者在30 d内因脑卒中再次住院治疗，全省30 d再入院率为4.09%。脑卒中再入院率的聚集区域主要集中在湖南省东北部和西部地区。地理加权回归显示合并症患者比重、每万人口医院数和每万人口基层医疗卫生机构数是脑卒中再入院的主要影响因素，且不同区域对再入院的影响方向和程度存在差异。结论: 湖南省脑卒中患者30 d再入院率及其主要影响因素具有空间分布异质性，重点防控区域主要集中在东北部和西部地区。建议西部地区加强对脑卒中合并症的治疗和医疗机构的建设，提升医疗服务质量；北部地区重视对于脑卒中合并症的治疗；东北部地区强化初级卫生保健工作建设。各地应因地制宜，采取针对性防治措施，有效控制脑卒中30 d再入院率。.
Keywords: 30-day readmission; geographic information systems; spatial distribution; stroke.