Chan Brian, Goldman L Elizabeth, Sarkar Urmimala, Schneidermann Michelle, Kessell Eric, Guzman David, Critchfield Jeff, Kushel Margot
Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143-1364, USA.
Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.
J Gen Intern Med. 2015 Dec;30(12):1788-94. doi: 10.1007/s11606-015-3362-y.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Care Transitions Measure (CTM-3) scores are patient experience measures used to determine hospital value-based purchasing reimbursement. Interventions to improve 30-day readmissions have met with mixed results, but less is known about their potential to improve the patient experience among older ethnically and linguistically diverse adults receiving care at safety-net hospitals. In this study, we assessed the effect of a nurse-led hospital-based care transition intervention on discharge-related patient experience in an older multilingual population of adults hospitalized at a safety-net hospital.
We randomized 700 inpatients aged 55 and older at an academic urban safety-net hospital. In addition to usual care, intervention participants received inpatient visits by a language-concordant study nurse and post-discharge phone calls from a language-concordant nurse practitioner to reinforce the care plan and to address acute complaints. We measured HCAHPS nursing, medication, and discharge communication domain scores and CTM-3 scores at 30 days after hospital discharge.
Of 685 participants who survived to 30 days, 90 % (n = 616) completed follow-up interviews. The mean age was 66.2 years; over half (54.2 %) of the participants had cognitive impairment, and 33.8 % had moderate to severe depression. The majority (62.1 %) of interviews were conducted in English; 23.3 % were conducted in Chinese and 14.6 % in Spanish. Study nurses spent an average of 157 min with intervention participants. Between intervention and usual care participants, CTM-3 scores (80.5 % vs 78.5 %; p = 0.18) and HCAHPS discharge communication domain scores (74.8 % vs 68.7 %; p = 0.11) did not differ, nor did HCAHPS scores in medication (44.5 % vs 53.1 %; p = 0.13) and nursing domains (67.9 % vs 64.9 %; p = 0.43). When stratified by language, no significant differences were seen.
An inpatient standalone transition-of-care intervention did not improve patient discharge experience. Older multi-lingual and cognitively impaired populations may require higher-intensity interventions post-hospitalization to improve discharge experience outcomes.
医院医疗服务提供者与系统消费者评估（HCAHPS）和护理过渡指标（CTM - 3）得分是用于确定医院基于价值购买报销的患者体验指标。改善30天再入院率的干预措施效果不一，但对于这些措施在改善安全网医院中接受治疗的老年种族和语言多样化成年人的患者体验方面的潜力，人们了解较少。在本研究中，我们评估了以护士为主导的基于医院的护理过渡干预措施对一家安全网医院住院的多语言老年成年人群出院相关患者体验的影响。
我们将一家城市学术安全网医院的700名55岁及以上的住院患者随机分组。除常规护理外，干预组参与者接受与语言匹配的研究护士的住院探访以及与语言匹配的执业护士出院后的电话随访，以强化护理计划并处理急性不适。我们在出院后30天测量HCAHPS护理、用药和出院沟通领域得分以及CTM - 3得分。
在685名存活至3术后30天的参与者中，90%（n = 616）完成了随访访谈。平均年龄为66.2岁；超过一半（54.2%）的参与者有认知障碍，33.8%有中度至重度抑郁。大多数（62.1%）访谈用英语进行；23.3%用中文进行，14.6%用西班牙语进行。研究护士与干预组参与者平均相处157分钟。干预组和常规护理组之间，CTM - 3得分（80.5%对78.5%；p = 0.18）和HCAHPS出院沟通领域得分（74.8%对68.7%；p = 0.11）没有差异，HCAHPS用药领域得分（44.5%对53.1%；p = 0.13）和护理领域得分（67.9%对64.9%；p = 0.43）也没有差异。按语言分层时，未观察到显著差异。
住院期间独立的护理过渡干预措施并未改善患者出院体验。老年多语言和认知障碍人群可能需要更高强度的出院后干预措施来改善出院体验结果。
