Bell Janice F, Whitney Robin L, Reed Sarah C, Poghosyan Hermine, Lash Rebecca S, Kim Katherine K, Davis Andra, Bold Richard J, Joseph Jill G
University of California (UC)-Davis.
University of California at San Francisco.
Oncol Nurs Forum. 2017 Mar 1;44(2):176-191. doi: 10.1011/17.ONF.176-191.
PURPOSE/OBJECTIVES: To review the existing literature on readmission rates, predictors, and reasons for readmission among adults with cancer. .
DATA SOURCES: U.S.-based empirical studies reporting readmission rates from January 2005 to December 2015 were identified using four online library databases-PubMed, CINAHL®, EconLit, and the online bibliography of the National Cancer Institute's Surveillance Epidemiology and End Results Program. Some articles were identified by the authors outside the database and bibliography searches. .
DATA SYNTHESIS: Of the 1,219 abstracts and 271 full-text articles screened, 56 studies met inclusion criteria. The highest readmission rates were observed in patients with bladder, pancreatic, ovarian, or liver cancer. Significant predictors of readmission included comorbidities, older age, advanced disease, and index length of hospital stay. Common reasons for readmission included gastrointestinal and surgical complications, infection, and dehydration. .
CONCLUSIONS: Clinical efforts to reduce the substantial readmission rates among adults with cancer may target high-rate conditions, infection prevention, proactive management of nausea and vomiting, and nurse-led care coordination interventions for older adult patients with multiple comorbid conditions and advanced cancer. .
IMPLICATIONS FOR NURSING: Commonly reported reasons for readmission were nursing-sensitive patient outcomes (NSPOs), amenable to nursing intervention in oncology settings. These findings underscore the important role oncology nurses play in readmission prevention by implementing evidence-based interventions to address NSPOs and testing their impact in future research.
目的/目标:回顾关于癌症成年患者再入院率、预测因素及再入院原因的现有文献。
通过四个在线图书馆数据库——PubMed、CINAHL®、EconLit以及美国国立癌症研究所监测、流行病学和最终结果计划的在线书目,识别2005年1月至2015年12月期间美国报告再入院率的实证研究。部分文章由作者在数据库和书目搜索之外识别。
在筛选的1219篇摘要和271篇全文文章中,56项研究符合纳入标准。膀胱癌、胰腺癌、卵巢癌或肝癌患者的再入院率最高。再入院的显著预测因素包括合并症、高龄、疾病晚期以及首次住院时长。再入院的常见原因包括胃肠道及手术并发症、感染和脱水。
降低癌症成年患者高再入院率的临床努力可针对高风险病症、预防感染、积极处理恶心和呕吐,以及针对患有多种合并症和晚期癌症的老年患者开展由护士主导的护理协调干预措施。
常见的再入院原因属于护理敏感型患者结局(NSPOs),在肿瘤护理环境中可通过护理干预解决。这些发现凸显了肿瘤护士在预防再入院方面的重要作用,即实施基于证据的干预措施以解决护理敏感型患者结局,并在未来研究中检验其效果。