Department of Health Policy, State University of New York at Albany, School of Public Health, One University Place, Room 171, Rensselaer, NY 12144, USA.
J Aging Health. 2010 Mar;22(2):169-82. doi: 10.1177/089826430353346.
To compare the perception of the determinants of preventable hospitalization among nursing home residents by surveying medical directors (MDs) and directors of nursing (DONs).
A survey (N = 52) was completed in January 2008. Data included resource availability, determinants of hospitalization, and nursing home practice. Multivariate linear regression examined the associations between potential determinants and preventable hospitalization.
Four significant determinants perceived by MDs to influence preventable hospitalization: MD/nurse practitioner (NP) access by pager, family preferences, access to medical history and lab/ electrocardiograph (EKG) reports, and physicians better paid to manage acutely ill residents (R(2) = .58). None of these factors were echoed by DONs (R(2) = .15). Whereas DONs perceived stat lab results on weekends were associated with increased hospitalization (p = .03), MDs did not (p = .28).
Our analysis showed that communication and consensus are important factors in the hospital transfer decision and that the discord in perceptions among MDs and DONs may complicate interventions to reduce preventable hospitalization.
通过调查医疗主任（MD）和护理主任（DON）来比较养老院居民对可预防住院的决定因素的看法。
于 2008 年 1 月完成了一项调查（N=52）。数据包括资源的可利用性、住院的决定因素和养老院的实践情况。多元线性回归分析了潜在决定因素与可预防住院之间的关系。
MD 认为有四个决定因素会影响可预防住院：通过寻呼机与 MD/护士从业者（NP）的联系、家庭偏好、获取病史和实验室/心电图（EKG）报告的机会，以及医生因管理急症患者而获得更高的报酬（R²=.58）。这些因素都没有得到 DON 的回应（R²=.15）。虽然 DON 认为周末获得即时实验室结果与住院增加有关（p=.03），但 MD 则不然（p=.28）。
我们的分析表明，沟通和共识是医院转院决策的重要因素，MD 和 DON 之间看法的不一致可能会使减少可预防住院的干预措施复杂化。
