School of Nursing, University of Minnesota, 6-135 Weaver-Densford Hall, Minneapolis, MN 55455, USA.
J Wound Ostomy Continence Nurs. 2011 Jan-Feb;38(1):77-87. doi: 10.1097/won.0b013e318202e4a6.
The purpose of the study was to discover which patient and support system characteristics and interventions documented by home health clinicians were associated with improvement in urinary and bowel incontinence contrasting logistic regression and data mining approaches.
Seventeen hundred ninety-three patients in this study experienced 2072 episodes of care. The study sample comprised all nonmaternity patients aged 18 years or older receiving skilled home health services in 2004. Subjects were drawn from a convenience sample of 15 home health agencies .
We completed a secondary analysis of data from 15 home health agencies' electronic health records. Data for this study were documented by home care clinicians using the Outcome and Assessment Information Set (OASIS) structured assessment form and the Omaha System interventions, which is a standardized terminology.
There were 684 patients with urinary incontinence and 187 with bowel incontinence. By discharge 38% improved in urinary incontinence and 45% improved their bowel incontinence. Using logistic regression, no patient or support system characteristics were identified that associated with improvement in either urinary or bowel incontinence, only a limited number of interventions were significant. A data mining decision tree was producible only for bowel incontinence, demonstrating a combination of patient and support system factors as well as selected interventions were important in determining whether patients would improve in bowel incontinence.
Home health patients have complex comorbid conditions requiring home care nurses to have broad, generalized knowledge. Future research is needed to determine if the inclusion of a certified WOC nurse would improve outcomes.
本研究旨在通过对比逻辑回归和数据挖掘方法，发现家庭健康临床医生记录的哪些患者和支持系统特征及干预措施与尿便失禁的改善有关。
本研究共有 1793 名患者经历了 2072 次护理。研究样本包括所有在 2004 年接受家庭健康服务的 18 岁及以上非产妇患者。研究对象来自 15 家家庭健康机构的便利样本。
我们对 15 家家庭健康机构的电子健康记录中的数据进行了二次分析。本研究的数据由家庭护理临床医生使用结局和评估信息集（OASIS）结构化评估表和奥马哈系统干预措施记录，这是一种标准化术语。
有 684 名患者患有尿失禁，187 名患者患有肠失禁。出院时，38%的尿失禁患者得到改善，45%的肠失禁患者得到改善。通过逻辑回归，没有发现与尿失禁或肠失禁改善相关的患者或支持系统特征，只有少数干预措施具有显著意义。仅可生成用于肠失禁的决策树数据挖掘，表明患者和支持系统因素以及选定的干预措施的组合在确定患者是否会改善肠失禁方面非常重要。
家庭健康患者有复杂的合并症，需要家庭健康护士具备广泛、全面的知识。需要进一步研究以确定是否纳入认证的 WOC 护士会改善结果。
