Forster Alan J, van Walraven Carl
Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
J Eval Clin Pract. 2007 Jun;13(3):346-51. doi: 10.1111/j.1365-2753.2006.00702.x.
Patients often experience complications when transitioning from hospital to home. These complications are frequently related to poor monitoring. An interactive voice response system (IVRS) could improve post-discharge monitoring.
To determine the feasibility and utility of an IVRS to monitor patients following hospital discharge.
Prospective cohort study at an academic health sciences centre.
Consecutive internal medicine patients who had a touch-tone telephone, spoke English, had no cognitive impairments and were discharged home.
Feasibility was defined as the proportion of patients reached by the IVRS and the proportion completing an IVRS-based survey. Utility was defined as the percentage of patients whose outcomes could have been changed by the IVRS.
We programmed the IVRS to call patients and administer a simple survey 48 hours after discharge. The survey's objective was to identify all patients with new health problems. Such patients were telephoned by a nurse to clarify and address the problem.
We enrolled 77 patients who were predominantly male (68%), elderly (median age 65 years) and chronically ill (median number of co-morbidities = 3). The IVRS reached 45 of the 77 patients (58.4%). Forty patients (51.9%) answered all questions on the survey. Twenty patients (26%, 95% CI 17%-37%) indicated new or worsening symptoms, problems with their medications, or requested to talk to the clinic nurse. For 10 patients (13%, 95% CI 7%-22%), the IVRS could have made a difference in their outcome.
Using an IVRS, we were able to identify several important new health concerns arising following hospital discharge. Subtle changes could increase the feasibility and utility of IVRS technology in improving post-discharge outcomes.
患者从医院过渡到家庭时经常会出现并发症。这些并发症通常与监测不力有关。交互式语音应答系统(IVRS)可以改善出院后的监测。
确定IVRS用于监测患者出院后情况的可行性和实用性。
在一所学术健康科学中心进行的前瞻性队列研究。
连续纳入的内科患者,这些患者拥有按键式电话、会说英语、无认知障碍且已出院回家。
可行性定义为IVRS联系到的患者比例以及完成基于IVRS的调查的患者比例。实用性定义为其结局可能因IVRS而改变的患者百分比。
我们对IVRS进行编程,使其在患者出院48小时后致电并进行一项简单调查。该调查的目的是识别所有有新健康问题的患者。此类患者会由护士致电以澄清并解决问题。
我们纳入了77名患者,其中大多数为男性(68%),老年患者(中位年龄65岁),且患有慢性病(合并症中位数 = 3)。IVRS联系到了77名患者中的45名(58.4%)。40名患者(51.9%)回答了调查中的所有问题。20名患者(26%,95%置信区间17% - 37%)表示有新的或加重的症状、用药问题或要求与诊所护士交谈。对于10名患者(13%,95%置信区间7% - 22%),IVRS可能会改变他们的结局。
通过使用IVRS,我们能够识别出院后出现的几个重要的新健康问题。细微的改变可以提高IVRS技术在改善出院后结局方面的可行性和实用性。