Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland
J Oncol Pract. 2016 Feb;12(2):151-2; e138-48. doi: 10.1200/JOP.2015.004812.
Hospital readmissions are often cited as a marker of poor quality of care. Limited data suggest some readmissions may be preventable depending upon definitions and available outpatient support.
General criteria to define preventable and not preventable admissions were developed before data collection began. The records of sequential nonsurgical oncology readmissions were reviewed independently by two reviewers. When the reviewers disagreed about assigning admissions as preventable or not preventable, a third reviewer was the tie breaker. The reasons for assigning admissions as preventable or not preventable were analyzed.
Seventy-two readmissions occurring among 69 patients were analyzed. The first two reviewers agreed that 18 (25%) of 72 were preventable and that 29 (40%) of 72 were not. A third reviewer found four of the split 25 cases to be preventable; therefore, the consensus preventability rate was 22 (31%) of 72. The most common causes of preventability were overwhelming symptoms in patients who qualified for hospice but were not participating in hospice and insufficient communication between patients and the care team about symptom burden. The most common reason for assignment of a not preventable admission was a high symptom burden among patients without strong indications for hospice or for whom aggressive outpatient management was inadequate. The median survival after readmission was 72 days.
A substantial proportion of oncology readmissions could be prevented with better anticipation of symptoms in high-risk ambulatory patients and enhanced communication about symptom burden between patients and physicians before an escalation that leads to an emergency department visit. Managing symptoms in patients who are appropriate for hospice is challenging. Readmission is a marker of poor prognosis.
医院再入院常被视为医疗质量差的标志。有限的数据表明，某些再入院可能是可以预防的，具体取决于定义和可用的门诊支持。
在开始收集数据之前，制定了一般标准来定义可预防和不可预防的入院。由两名审核员独立审查连续非手术肿瘤再入院的记录。当审核员对将入院归类为可预防或不可预防存在分歧时，第三名审核员做出裁决。分析了将入院归类为可预防或不可预防的原因。
对 69 名患者中的 72 例再入院进行了分析。前两名审核员一致认为，72 例中有 18 例（25%）是可预防的，72 例中有 29 例（40%）是不可预防的。第三名审核员发现 25 例中有 4 例是可预防的；因此，可预防率为 72 例中的 22 例（31%）。可预防的最常见原因是符合临终关怀条件但未参加临终关怀的患者出现症状加重，以及患者与护理团队之间关于症状负担的沟通不足。不可预防入院的最常见原因是症状负担高的患者没有强烈的临终关怀指征，或对患者进行积极的门诊管理不足。再入院后的中位生存时间为 72 天。
通过更好地预测高风险门诊患者的症状，并在患者与医生之间加强关于症状负担的沟通，以避免病情恶化导致急诊就诊，可以预防相当一部分肿瘤再入院。管理适合临终关怀的患者的症状具有挑战性。再入院是预后不良的标志。
