1 Department of Medicine, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania.
J Palliat Med. 2013 Oct;16(10):1290-3. doi: 10.1089/jpm.2013.0213. Epub 2013 Sep 5.
This study examined the impact of palliative home nursing care on rates of hospital 30-day readmissions.
The electronic health record based retrospective cohort study was performed within home care and palliative home care programs. Participants were home care patients discharged from one of three urban teaching hospitals. Outcome measures were propensity score matched rates of hospital readmissions within 30 days of hospital discharge.
Of 406 palliative home care patients, matches were identified for 392 (96%). Of 15,709 home care patients, 890 were used at least once as a match for palliative care patients, for a total final sample of 1282. Using the matched sample we calculated the average treatment effect for treated patients. In this sample, palliative care patients had a 30-day readmission probability of 9.1% compared to a probability of 17.4% in the home care group (mean ATT: 8.3%; 95% confidence interval [CI] 8.0%-8.6%). This effect persisted after adjustment for visit frequency.
Palliative home care may offer benefits to health systems by allowing patients to remain at home and thereby avoiding 30-day rehospitalizations.
本研究旨在探讨姑息治疗居家护理对患者 30 天内再入院率的影响。
本研究为基于电子健康记录的回顾性队列研究，在居家护理和姑息治疗居家护理项目中开展。参与者为从三家城市教学医院出院的居家护理患者。主要结局指标为出院后 30 天内再次住院的倾向性评分匹配率。
406 例姑息治疗居家护理患者中，有 392 例（96%）匹配成功。在 15709 例居家护理患者中，有 890 例至少被一次用作姑息治疗患者的匹配对象，最终总样本量为 1282 例。我们使用匹配样本计算了治疗患者的平均处理效应。在该样本中，姑息治疗患者的 30 天再入院率为 9.1%，而居家护理组的再入院率为 17.4%（平均 ATT：8.3%；95%置信区间[CI]8.0%-8.6%）。这种效果在调整了就诊频率后仍然存在。
姑息治疗居家护理通过允许患者居家，从而避免 30 天内再次住院，可能为医疗系统带来益处。
