失约于初级保健预约：糖尿病患者后续急性护理的利用情况。
No-shows to primary care appointments: subsequent acute care utilization among diabetic patients.
机构信息
School of Nursing, College of Health and Human Sciences, Purdue University, West Lafayette, IN 47907-2069, USA.
出版信息
BMC Health Serv Res. 2012 Sep 6;12:304. doi: 10.1186/1472-6963-12-304.
BACKGROUND
Patients who no-show to primary care appointments interrupt clinicians' efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics.
METHODS
A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6 months (182 days) following the patient's last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model.
RESULTS
The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d. = 0.83) for no-shows and 0.14 (s.d. = 0.63) for those who attended (p < 0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR = 1.60, CI = 1.17-2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d. = 1.48) for no-shows and 0.38 (s.d. = 1.05) for those who attended (p < 0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization.
CONCLUSIONS
No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.
背景
患者不参加初级保健预约会打断临床医生提供连续护理的努力。先前的文献表明，糖尿病患者的失约情况很常见。本研究的目的是评估初级保健预约的失约是否与糖尿病患者未来急诊就诊或住院的风险增加有关。
方法
本研究采用前瞻性队列研究，数据来自印第安纳州一家医疗中心的 8787 名成年糖尿病患者的门诊就诊记录。研究结果为患者最后一次预约的初级保健后 6 个月（182 天）内的住院或急诊就诊。使用 Andersen-Gill 扩展的 Cox 比例风险模型分别评估住院和急诊就诊的风险。对与失约状态和急性护理利用相关的变量进行调整，如性别、年龄、种族、保险和合并症状态。为每个模型计算了预约前六个月内急性护理服务利用与失约之间的交互作用。
结果
最后一次预约的初级保健后 6 个月内的住院率，失约组为 0.22（标准差=0.83），就诊组为 0.14（标准差=0.63）（p<0.0001）。仅在过去六个月内有住院史的糖尿病患者中，失约与更高的住院风险相关。在过去六个月内有住院史的糖尿病患者中，失约的患者随后再次住院的风险增加了 60%（HR=1.60，CI=1.17-2.18），而就诊的患者则无此风险。最后一次预约的初级保健后 6 个月内的急诊就诊率，失约组为 0.56（标准差=1.48），就诊组为 0.38（标准差=1.05）（p<0.0001）；调整了混杂因素后，失约状态与随后的急诊就诊利用无显著相关性。
结论
在最近住院的糖尿病患者中，初级保健预约的失约与住院风险增加有关。
Zotero 插件