Kim Luke D, Kou Lei, Hu Bo, Gorodeski Eiran Z, Rothberg Michael B
Center for Geriatric Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
J Hosp Med. 2017 Apr;12(4):238-244. doi: 10.12788/jhm.2710.
About one-fifth of hospitalized Medicare beneficiaries are discharged to skilled nursing facilities (SNFs) for post-acute care. Readmissions are common but interventions to reduce readmissions are scarce.
To assess the impact of a connected care model on 30-day hospital readmission rates among patients discharged to SNFs.
Retrospective cohort.
SNFs that receive referrals from an academic medical center in Cleveland, Ohio.
All patients admitted to Cleveland Clinic main campus between January 1, 2011 and December 31, 2014 and subsequently discharged to 7 intervention SNFs or 103 control SNFs.
Hospital-employed physicians and advanced practice professionals (nurse practitioners and physician assistants) visited SNF patients 4 to 5 times per week.
During the study period, 13,544 patients were discharged to SNFs within a 25-miles radius of Cleveland Clinic main campus. Of these, 3334 were discharged to 7 intervention SNFs and 10,201 were discharged to 103 usualcare SNFs. During the intervention phase (2013-2014), adjusted 30-day readmission rates declined at the intervention SNFs (28.1% to 21.7%, P < 0.001), while there was a slight increase at control SNFs (27.1 % to 28.5%, P < 0.001). The absolute reductions ranged from 4.6% for patients at low risk for readmission to 9.1% for patients at high risk, and medical patients benefited more than surgical patients.
A program of frequent visits by hospital employed physicians and advanced practice professionals at SNFs can reduce 30-day readmission rates. Journal of Hospital Medicine 2017;12:238-244.
约五分之一住院的医疗保险受益人出院后前往专业护理机构（SNFs）接受急性后期护理。再入院情况很常见，但减少再入院的干预措施却很少。
评估一种联合护理模式对出院至SNFs的患者30天内医院再入院率的影响。
回顾性队列研究。
俄亥俄州克利夫兰市一所学术医疗中心转诊的SNFs。
2011年1月1日至2014年12月31日期间入住克利夫兰诊所主院区且随后出院至7家干预性SNFs或103家对照性SNFs的所有患者。
医院雇佣的医生和高级执业专业人员（执业护士和医师助理）每周对SNFs患者进行4至5次访视。
在研究期间，13544名患者从克利夫兰诊所主院区半径25英里范围内出院至SNFs。其中，3334名患者出院至7家干预性SNFs，10201名患者出院至103家常规护理SNFs。在干预阶段（2013 - 2014年），干预性SNFs的调整后30天再入院率下降（从28.1%降至21.7%，P < 0.001），而对照性SNFs则略有上升（从27.1%升至28.5%，P < 0.001）。绝对降低率范围从再入院低风险患者的4.6%到高风险患者的9.1%，内科患者比外科患者受益更多。
医院雇佣的医生和高级执业专业人员对SNFs患者进行频繁访视的项目可降低30天再入院率。《医院医学杂志》2017年；12:238 - 244。
