意大利当地一家卫生机构中老年人的出院计划与连续性护理：养老院模式是否能降低医院再入院率和死亡率？
Hospital discharge planning and continuity of care for aged people in an Italian local health unit: does the care-home model reduce hospital readmission and mortality rates?
作者信息
Damiani Gianfranco, Federico Bruno, Venditti Antonella, Sicuro Lorella, Rinaldi Silvia, Cirio Franco, Pregno Cristiana, Ricciardi Walter
机构信息
Department of Public Health, Catholic University of Sacred Heart, Largo F. Vito 1, Rome, Lazio, Italy.
出版信息
BMC Health Serv Res. 2009 Feb 4;9:22. doi: 10.1186/1472-6963-9-22.
BACKGROUND
Hospital discharge planning is aimed to decrease length of stay in hospitals as well as to ensure continuity of health care after being discharged. Hospitalized patients in Turin, Italy, who are in need of medical, social and rehabilitative care are proposed as candidates to either discharge planning relying on a care-home model (DPCH) for a period of about 30 days, or routine discharge care. The aim of this study was to evaluate whether a hospital DPCH that was compared with routine care, improved patients' outcomes in terms of reduced hospital readmission and mortality rates in patients aged 64 years and older.
METHODS
In a retrospective observational cohort study a sample of 380 subjects aged 64 years and over was examined. Participants were discharged from the hospital S. Giovanni Bosco in Turin, Italy from March 1st, 2005 to February 28th, 2006. Of these subjects, 107 received routine discharge care while 273 patients were referred to care-home (among them, 99 received a long-term care intervention (LTCI) afterwards while 174 did not). Data was gathered from various administrative and electronic databases. Cox regression models were used to evaluate factors associated with mortality and hospital readmission.
RESULTS
When socio-demographic factors, underlying disease and disability were taken into account, DPCH decreased mortality rates only if it was followed by a LTCI: compared to routine care, the Hazard Ratio (HR) of death was 0.36 (95% Confidence Interval (CI): 0.20 - 0.66) and 1.15 (95%CI: 0.77 - 1.74) for DPCH followed by LTCI and DPCH not followed by LTCI, respectively. On the other hand, readmission rates did not significantly differ among DPCH and routine care, irrespective of the implementation of a LTCI: HRs of hospital readmission were 1.01 (95%CI: 0.48 - 2.24) and 1.18 (95%CI: 0.71 - 1.96), respectively.
CONCLUSION
The use of DPCH after hospital discharge reduced mortality rates, but only when it was followed by a long-term health care plan, thus ensuring continuity of care for elderly participants.
背景
医院出院计划旨在缩短住院时间，并确保出院后医疗保健的连续性。意大利都灵的住院患者，若需要医疗、社会和康复护理，将被提议作为候选对象，要么接受为期约30天的基于护理院模式的出院计划（DPCH），要么接受常规出院护理。本研究的目的是评估与常规护理相比，医院DPCH是否能改善64岁及以上患者的预后，降低医院再入院率和死亡率。
方法
在一项回顾性观察队列研究中，对380名64岁及以上的受试者进行了检查。参与者于2005年3月1日至2006年2月28日从意大利都灵的圣乔瓦尼·博斯科医院出院。在这些受试者中，107人接受了常规出院护理，而273名患者被转至护理院（其中，99人随后接受了长期护理干预（LTCI），174人未接受）。数据从各种行政和电子数据库中收集。使用Cox回归模型评估与死亡率和医院再入院相关的因素。
结果
在考虑社会人口学因素、基础疾病和残疾情况后，DPCH仅在随后进行LTCI时才降低死亡率：与常规护理相比，接受LTCI的DPCH和未接受LTCI的DPCH的死亡风险比（HR）分别为0.36（95%置信区间（CI）：0.20 - 0.66）和1.15（95%CI：0.77 - 1.74）。另一方面，无论是否实施LTCI，DPCH和常规护理之间的再入院率没有显著差异：医院再入院的HR分别为1.01（95%CI：0.48 - 2.24）和1.18（95%CI：0.71 - 1.96）。
结论
出院后使用DPCH可降低死亡率，但仅在随后有长期医疗保健计划时才如此，从而确保老年参与者的护理连续性。
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