Fortinsky Richard H, Madigan Elizabeth A, Sheehan T Joseph, Tullai-McGuinness Susan, Fenster Juliane R
University of Connecticut Health Center, USA.
West J Nurs Res. 2006 Dec;28(8):902-17. doi: 10.1177/0193945906286810.
This study determined factors associated with an increased risk of ending Medicare home health care because of hospitalization and examined specific types of and reasons for hospitalization. Sample members (N = 922) were followed from admission to discharge as they received home care from Ohio Medicare-certified home care agencies between December 1999 and March 2002. Potential patient-level risk factors were predisposing, enabling, or need variables, and an agency-level variable denoting hospital affiliation or free-standing status was examined as a second-level risk factor. Among those hospitalized (18.3%), more than 80.0% experienced emergency hospitalizations, mostly for acute exacerbations of chronic diseases. Statistically significant risk factors for hospitalization included dyspnea severity, functional disability level, skin or wound problems, diabetes, case mix score, and guarded rehabilitation prognosis. Home care agencies might reduce hospitalizations by using clinical prognosis as a key resource for team communication and by helping patients and families anticipate potential acute exacerbations of chronic diseases and manage these events at home.
本研究确定了因住院而增加医疗保险家庭医疗保健终止风险的相关因素，并检查了住院的具体类型和原因。在1999年12月至2002年3月期间，对样本成员（N = 922）从入院到出院进行了跟踪，他们接受了俄亥俄州医疗保险认证的家庭护理机构提供的家庭护理。潜在的患者层面风险因素为易患因素、促成因素或需求变量，一个表示医院附属关系或独立状态的机构层面变量作为二级风险因素进行了检查。在那些住院的患者中（18.3%），超过80.0%经历了急诊住院，主要是由于慢性病的急性加重。住院的统计学显著风险因素包括呼吸困难严重程度、功能残疾水平、皮肤或伤口问题、糖尿病、病例组合评分以及康复预后不佳。家庭护理机构可以通过将临床预后作为团队沟通的关键资源，并帮助患者和家庭预测慢性病的潜在急性加重情况以及在家中处理这些情况，来减少住院次数。
