Division of Primary Care Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Kogod Center of Aging, Mayo Clinic, Rochester, MN, USA.
Division of Health Care Policy & Research, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA.
Healthc (Amst). 2016 Mar;4(1):30-5. doi: 10.1016/j.hjdsi.2015.06.006. Epub 2015 Jul 7.
Care transition programs can potentially reduce 30 day readmission; however, the effect on long-term hospital readmissions is still unclear.
We compared short-term (30 day) and long-term (180 day) utilization of participants enrolled in care transitions versus those matched referents eligible but not enrolled.
This cohort study was conducted from January 1, 2011 until June 30, 2013 within a primary care academic practice.
Patients at high risk for hospital readmission based on age and comorbid health conditions had participated in care transitions group (cases) or usual care (referent).
The primary outcomes were 30, 90, and 180 day hospital readmissions.. Secondary outcomes included: mortality; emergency room visits and days; combined rehospitalizations and emergency room visits; and total intensive care unit days. Cox proportional hazard models using propensity score matching were used to assess rehospitalization, emergency room visits and mortality. Poisson regression models were used to compare the numbers of hospital days.
Compared to referent (n=365), Mayo Clinic Care Transitions patients exhibited a lower 30 day rehospitalization rate compared to referent; 12.4% (95% CI 8.9-15.7) versus 20.1% (95% CI 15.8-24.1%), respectively (P=0.002). At 180-days, there was no difference in rehospitalization between transitions and referent; 39.9% (95% CI 34.6-44.9%) versus 44.8% (95% CI 39.4-49.8%), (P=0.07).
We observed a reduction in 30 day rehospitalization rates among those enrolled in care transitions compared to referent. However, this effect was not sustained at 180 days. More work is needed to identify how the intervention can be sustained beyond 30 days.
护理过渡计划有可能降低 30 天再入院率；然而，其对长期住院再入院的影响尚不清楚。
我们比较了参加护理过渡计划的参与者（病例组）与符合条件但未参加的匹配对照者（对照组）的短期（30 天）和长期（180 天）利用情况。
这项队列研究于 2011 年 1 月 1 日至 2013 年 6 月 30 日在一家初级保健学术实践中进行。
根据年龄和合并健康状况，有住院风险的患者参加了护理过渡组（病例组）或常规护理（对照组）。
主要结局是 30、90 和 180 天的住院再入院率。次要结局包括：死亡率；急诊就诊次数和天数；再住院和急诊就诊的联合次数；以及重症监护病房总天数。使用倾向评分匹配的 Cox 比例风险模型评估再入院、急诊就诊和死亡率。使用泊松回归模型比较住院天数。
与对照组（n=365）相比，梅奥诊所护理过渡组患者的 30 天再入院率较低，为 12.4%（95%CI 8.9-15.7），而对照组为 20.1%（95%CI 15.8-24.1%）（P=0.002）。在 180 天，过渡组与对照组之间的再入院率无差异，分别为 39.9%（95%CI 34.6-44.9%）和 44.8%（95%CI 39.4-49.8%）（P=0.07）。
与对照组相比，我们观察到参加护理过渡计划的患者 30 天再入院率降低。然而，这种效果在 180 天并未持续。需要进一步研究如何将干预措施维持 30 天以上。
