药师-医院协作护理过渡计划对30天再入院可能性的影响。

The effect of a collaborative pharmacist-hospital care transition program on the likelihood of 30-day readmission.

作者信息

Kirkham Heather S, Clark Bobby L, Paynter Jacquelyn, Lewis Geraint H, Duncan Ian

机构信息

Heather S. Kirkham, Ph.D., M.P.H., is Manager, Clinical Outcomes and Analytics; and Bobby L. Clark, Ph.D., M.H.A., M.A., M.S.Pharm., M.S., is Senior Director, Clinical Outcomes and Analytics, Walgreen Company, Deerfield, IL. Jacquelyn Paynter, M.P.H., B.S.N., RN, CCM, is Director of Case Management, Rockdale Medical Center, Conyers, GA; at the time of writing she was Executive Director, Care Management, DeKalb Medical, Decatur, GA. Geraint H. Lewis, FRCP, FFPH, is Chief Data Officer, Patients and Information, National Health Service England, Leeds, United Kingdom. Ian Duncan, FSA MAAA, is Vice President, Clinical Outcomes and Analytics, Walgreen Company.

出版信息

Am J Health Syst Pharm. 2014 May 1;71(9):739-45. doi: 10.2146/ajhp130457.

DOI:10.2146/ajhp130457

PMID:24733137

Abstract

PURPOSE

The effect of a collaborative pharmacist-hospital care transition program on the likelihood of 30-day readmission was evaluated.

METHODS

This retrospective cohort study was conducted in two acute care hospitals within the same hospital system in the southeastern United States. One hospital initiated a care transition program in January 2011; the other hospital did not have such a program. All patients who were discharged from either hospital to home from January 1, 2010, through December 31, 2011, were included in the study. The two key program components included bedside delivery of postdischarge medications and follow-up telephone calls two to three days after discharge. The likelihood of readmission was assessed using multiple logistic regression.

RESULTS

Over the 2-year study period, 19,659 unique patients had 26,781 qualifying index admissions, 2,523 of which resulted in a readmission within 30 days of discharge. After adjusting for various demographic and clinical characteristics, the usual care group (i.e., patients who did not participate in the program) had nearly twice the odds of readmission within 30 days (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.35-2.67), compared with the intervention group (i.e., program participants). For patients age 65 years or older, those in the usual care group had a sixfold increase in the odds of a 30-day readmission (OR, 6.05; 95% CI, 1.92-19.00) relative to those in the intervention group.

CONCLUSION

A care transition program was associated with a lower likelihood of readmission and had a greater effect on older patients.

摘要

目的

评估药师与医院协作的护理过渡项目对30天再入院可能性的影响。

方法

这项回顾性队列研究在美国东南部同一医院系统内的两家急症医院开展。一家医院于2011年1月启动了护理过渡项目；另一家医院没有此类项目。2010年1月1日至2011年12月31日期间从两家医院出院回家的所有患者均纳入研究。该项目的两个关键组成部分包括出院后药物床边发放以及出院后两到三天的随访电话。使用多因素逻辑回归评估再入院的可能性。

结果

在为期2年的研究期间，19659名不同患者有26781次符合条件的首次入院，其中2523次导致出院后30天内再次入院。在调整了各种人口统计学和临床特征后，常规护理组（即未参与该项目的患者）在30天内再入院的几率几乎是干预组（即项目参与者）的两倍（比值比[OR]，1.90；95%置信区间[CI]，1.35 - 2.67）。对于65岁及以上的患者，常规护理组30天再入院的几率相对于干预组增加了五倍（OR，6.05；95% CI，1.92 - 19.00）。