Greysen S Ryan, Harrison James D, Kripalani Sunil, Vasilevskis Eduard, Robinson Edmondo, Metlay Joshua, Schnipper Jeffery L, Meltzer David, Sehgal Neil, Ruhnke Gregory W, Williams Mark V, Auerbach Andrew D
Division of Hospital Medicine, University of California, San Francisco, CA, USA.
Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA.
BMJ Qual Saf. 2017 Jan;26(1):33-41. doi: 10.1136/bmjqs-2015-004570. Epub 2016 Jan 14.
Patient concerns at or before discharge inform many transitional care interventions; few studies examine patients' perceptions of self-care and other factors related to readmission.
To characterise patient-reported or caregiver-reported factors contributing to readmission.
DESIGN, SETTING AND PARTICIPANTS: Cross-sectional, national study of general medicine patients readmitted within 30 days at 12 US hospitals. Interviews included multiple-choice survey and open-ended survey questions of patients or their caregivers.
Multiple-choice survey quantified post-discharge difficulty in seven domains of self-care: medication use, contacting providers, transportation, basic needs (eg, food and shelter), diet, social support and substance abuse. Open-ended responses were coded into themes that added depth to the domains above or captured additional patient-centred concerns.
We interviewed 1066 readmitted patients. 91% reported understanding their discharge plan; however, only 37% reported that providers asked about barriers to carrying out the plan. 52% reported experiencing difficulty in ≥1 self-care domains ranging in frequency from 22% (diet) to 7% (substance use); 26% experienced difficulty in two or more domains. Among 508 patients (48% overall) who reported no difficulties in these domains, two-thirds either could not attribute their readmission to any specific difficulty (34%) or attributed their readmission to progression or persistence of their disease despite following their discharge plan (31%). Only 20% attributed their readmission to early discharge (8%), poor-quality hospital care (6%) or issues such as inadequate discharge instructions or follow-up care (6%).
The study population included only patients readmitted at academic medical centres and may not be representative of community-based care.
Patients readmitted within 30 days reported understanding their discharge plans, but frequent difficulties in self-care and low anticipatory guidance for resolving these issues after discharge.
出院时或出院前患者的担忧为许多过渡性护理干预措施提供了依据；很少有研究调查患者对自我护理以及与再入院相关的其他因素的看法。
描述患者报告或照顾者报告的导致再入院的因素。
设计、背景和参与者：对美国12家医院在30天内再次入院的普通内科患者进行的横断面全国性研究。访谈包括对患者或其照顾者的多项选择调查和开放式调查问题。
多项选择调查对出院后自我护理的七个领域的困难进行了量化：药物使用、联系医疗服务提供者、交通、基本需求（如食物和住所）、饮食、社会支持和药物滥用。开放式回答被编码为主题，这些主题为上述领域增添了深度，或涵盖了其他以患者为中心的担忧。
我们采访了1066名再次入院的患者。91%的患者报告理解他们的出院计划；然而，只有37%的患者报告医护人员询问了执行该计划的障碍。52%的患者报告在≥1个自我护理领域存在困难，频率从22%（饮食）到7%（药物使用）不等；26%的患者在两个或更多领域存在困难。在508名（总体占48%）报告在这些领域没有困难的患者中，三分之二的患者要么无法将其再入院归因于任何特定困难（34%），要么将其再入院归因于尽管遵循了出院计划但疾病仍进展或持续（31%）。只有20%的患者将其再入院归因于提前出院（8%）、医院护理质量差（6%）或出院指导不足或后续护理等问题（6%）。
研究人群仅包括在学术医疗中心再次入院的患者，可能不代表社区护理情况。
在30天内再次入院的患者报告理解他们的出院计划，但在自我护理方面经常存在困难，且出院后解决这些问题的预期指导不足。
