Tanaka Makoto, Yamamoto Hiromi, Kita Toru, Yokode Masayuki
Department of Social Service, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Arch Gerontol Geriatr. 2008 Jul-Aug;47(1):1-7. doi: 10.1016/j.archger.2007.06.002. Epub 2007 Aug 9.
Successful home return from hospital admission is a key issue to provide quality healthcare in a society with numerous older subjects. Therefore, a screening method for early identification of patients who require intensive, non-routine discharge planning needs to be established. We have developed a 7-item screening sheet (the screening sheet at admission: SSA) and conducted a prospective cohort study to examine its usefulness in predicting the need for non-routine discharge planning. The SSA score yielded an area under receiver operating characteristic curve of 0.82. Moreover, a cutoff score of 2 or higher gave sensitivity, specificity and positive and negative predictive values of 0.82, 0.72, 0.13 and 0.99, respectively. A stepwise logistic regression model demonstrated that age of 75 years or more and impairment in basic activities of daily living (ADL) were significantly associated with requirement for non-routine discharge planning in surgical patients, while living alone or with a spouse aged 75 or older and readmission within 1 month were also significant predictors in medical patients. The SSA score may be useful in identifying patients who need further assessment and planning. While the four items were particularly important predictors, differences between medical and surgical patients should also be considered.
对于一个老年人口众多的社会而言，成功从住院状态回归家庭是提供优质医疗保健服务的关键问题。因此，需要建立一种筛查方法，以便早期识别那些需要密集的、非常规出院计划的患者。我们开发了一份包含7个条目的筛查表（入院时筛查表：SSA），并进行了一项前瞻性队列研究，以检验其在预测非常规出院计划需求方面的效用。SSA评分得出的受试者工作特征曲线下面积为0.82。此外，截断分数为2分或更高时，其灵敏度、特异度、阳性预测值和阴性预测值分别为0.82、0.72、0.13和0.99。逐步逻辑回归模型表明，75岁及以上的年龄以及日常生活活动能力（ADL）受损与外科手术患者的非常规出院计划需求显著相关，而独居或配偶年龄在75岁及以上以及在1个月内再次入院也是内科患者的重要预测因素。SSA评分可能有助于识别那些需要进一步评估和计划的患者。虽然这四个条目是特别重要的预测因素，但也应考虑内科和外科患者之间的差异。
