Kwan Janice L, Morgan Matthew W, Stewart Thomas E, Bell Chaim M
Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Hosp Med. 2015 Dec;10(12):799-803. doi: 10.1002/jhm.2442. Epub 2015 Aug 10.
The current climate of increasing patient complexity coupled with rising costs have prompted the need for adaptive innovation. There are limited data describing inpatient interventions targeting improvements in both communication and transitional care.
Evaluate the patient navigator (PN) program, an innovative inpatient intervention intended to enhance navigation through the complexity of hospital admissions for patients and providers.
PNs were dedicated patient-care facilitators without clinical responsibilities integrated as full members of the inpatient care team responsible for enhancing communication between and among patients and providers.
Observational retrospective cohort study.
All patients admitted to the general medical service between July 2010 and March 2014.
Academic medical center.
Primary outcomes were hospital length of stay (LOS) and 30-day readmission rate matched by case mix group, age category, and resource intensity weight.
Our matched cohort included 5628 admissions (4592 patients) exposed and 2213 admissions (1920 patients) not exposed to PNs. Admissions with PNs were 1.3 days (21%) shorter than admission without PNs (6.2 vs 7.5 days, P < 0.001). Thirty-day readmission rate was not different between the 2 groups (13.1 vs 13.8%, P = 0.48).
Implementation of this intervention was associated with a reduction in LOS without an increase in 30-day readmission.
当前患者病情日益复杂且成本不断上升的形势促使人们需要进行适应性创新。描述旨在改善沟通和过渡性护理的住院干预措施的数据有限。
评估患者导航员（PN）项目，这是一项创新性的住院干预措施，旨在帮助患者和医护人员更好地应对复杂的住院流程。
PN是专门的患者护理协调员，不承担临床职责，作为住院护理团队的正式成员，负责加强患者与医护人员之间的沟通。
观察性回顾性队列研究。
2010年7月至2014年3月期间入住普通内科的所有患者。
学术医疗中心。
主要结局指标为住院时间（LOS）和30天再入院率，按病例组合、年龄类别和资源强度权重进行匹配。
我们的匹配队列包括5628例接受PN干预的入院患者（4592名患者）和2213例未接受PN干预的入院患者（1920名患者）。接受PN干预的入院患者住院时间比未接受干预的患者短1.3天（21%）（6.2天对7.5天，P < 0.001）。两组的30天再入院率无差异（13.1%对13.8%，P = 0.48）。
实施该干预措施可缩短住院时间，且不会增加30天再入院率。
