White Brett, Carney Patricia A, Flynn Jessie, Marino Miguel, Fields Scott
Department of Family Medicine, Oregon Health & Science University, Portland. Email:
J Fam Pract. 2014 Feb;63(2):67-73.
To assess the impact of a multicomponent intervention on 30-day hospital readmissions in a group of primary care practices that undertook practice transformation, compared with rates in usual-care practices that admitted patients to the same hospital service.
Four primary care clinics enhanced patient care coordination with care managers and inpatient care teams, and developed and used hospital readmission reports to monitor readmission rates. Patient readmissions to the hospital were analyzed over a 12-month period from May 2012 through April 2013, among patients who fell into 2 groups. Group 1 patients were those cared for by the primary care clinics that implemented transformation activities and who were admitted to the hospital associated with the practices. Group 2 patients were seen at clinics in the same catchment area that did not undertake any known practice redesign activities (usual care group).
A total of 961 patients were included in analyses; 685 (71.3%) were in Group 1, and 276 (28.7%) were in Group 2. Readmissions among Group 1 patients decreased from 27% to 7.1% (P=.02), and readmissions in Group 2 were variable with a nonsignificant trend (P=.53). The unadjusted regression model that compared the interaction between Group 1 and Group 2 patients found a significant difference in readmissions (P=.05).
Developing a multicomponent intervention appears to have a significant impact on reducing hospital readmissions. Primary care groups seeking to reduce hospital readmissions should consider implementing similar processes.
评估多组分干预措施对一组进行实践转型的基层医疗实践机构中30天内医院再入院情况的影响，并与将患者收治到同一医院科室的常规护理实践机构的再入院率进行比较。
四家基层医疗诊所加强了与护理经理和住院护理团队的患者护理协调，并制定和使用医院再入院报告来监测再入院率。对2012年5月至2013年4月这12个月期间两组患者的医院再入院情况进行了分析。第1组患者为由实施转型活动的基层医疗诊所护理且入住与这些诊所相关医院的患者。第2组患者为在同一集水区内未进行任何已知实践重新设计活动的诊所就诊的患者（常规护理组）。
共有961名患者纳入分析；第1组有685名（71.3%），第2组有276名（28.7%）。第1组患者的再入院率从27%降至7.1%（P = 0.02），第2组的再入院率有波动且无显著趋势（P = 0.53）。比较第1组和第2组患者之间相互作用的未调整回归模型发现再入院情况存在显著差异（P = 0.05）。
开展多组分干预措施似乎对降低医院再入院率有显著影响。寻求降低医院再入院率的基层医疗组应考虑实施类似流程。
