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心胸外科服务中早期(30天)再入院的前瞻性关联因素。

Prospective correlates of early (30 day) readmissions on a Cardiothoracic Surgery Service.

作者信息

Ketterer Mark W, Chawa Mansi, Paone Gaetano

机构信息

a Department of Behavioral Health , Henry Ford Hospital/WSU , Detroit , MI , USA.

b Behavioral Health , Henry Ford Health System , Detroit , MI , USA.

出版信息

Psychol Health Med. 2017 Sep;22(8):947-954. doi: 10.1080/13548506.2017.1287408. Epub 2017 Feb 6.

DOI:10.1080/13548506.2017.1287408
PMID:28161983
Abstract

Known to vary widely among hospitals for unclear reasons, early readmissions are associated with higher mortality and are suspected to frequently be due to inadequate discharge preparation/planning. It has been previously documented that the strongest and most consistent predictor of early readmissions in CHF patients is chronic cognitive impairment, and compensatory assistance with adherence on discharge improves early readmission rates. Prospective observational study. The present investigation examined multiple putative perioperative predictors of early readmission in a hospitalized Cardiothoracic Surgery Service. A subtest of the Mini-Cog, Short Term Memory, was the strongestunivariate predictor of early readmissions (p < .001), but the overall Mini-Cog (p = .024), Age (p = .045), Number of Admissions over the Preceding Year (p = .036), an Anxiety Scale (p = .035), Years of Education (p = .055) and a Depression Scale (p = .056) also demonstrated covariation. In a Logistic Regression, only Short Term Memory survived as a predictor variable (p = .007), correctly classifying 76% of patients. Chronic cognitive impairment is a predictor of early readmissions in Cardiothoracic patients. A brief bedside exam interpreted in medical context may permit identification of patients requiring familial assistance for adherence on discharge.

摘要

早期再入院率在不同医院之间差异很大,原因不明,它与较高的死亡率相关,并且人们怀疑这常常是由于出院准备/计划不足所致。此前已有文献记载,慢性认知障碍是心力衰竭患者早期再入院最强且最一致的预测因素,而出院时在依从性方面给予补偿性帮助可提高早期再入院率。前瞻性观察研究。本调查研究了心胸外科住院患者早期再入院的多个假定围手术期预测因素。简易认知功能测试(Mini-Cog)的一个子测试,即短期记忆,是早期再入院最强的单变量预测因素(p < 0.001),但总体简易认知功能测试(p = 0.024)、年龄(p = 0.045)、前一年的入院次数(p = 0.036)、焦虑量表(p = 0.035)、受教育年限(p = 0.055)和抑郁量表(p = 0.056)也显示出协变关系。在逻辑回归分析中,只有短期记忆作为预测变量留存下来(p = 0.007),正确分类了76%的患者。慢性认知障碍是心胸外科患者早期再入院的一个预测因素。在医疗背景下进行的简短床边检查可能有助于识别那些出院时需要家人协助以坚持治疗的患者。

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引用本文的文献

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The association of cognitive impairment as screened by the Mini-Cog with long term post-hospitalization outcomes.认知障碍(通过 Mini-Cog 筛查)与长期住院后结局的关系。
Arch Gerontol Geriatr. 2019 Nov-Dec;85:103916. doi: 10.1016/j.archger.2019.103916. Epub 2019 Jul 18.