Kaiser Permanente Southern California, Pasadena, CA.
Department of Internal Medicine, Center for Health Services Research, University of Kentucky, Lexington, KY.
J Am Med Dir Assoc. 2017 Sep 1;18(9):797-798. doi: 10.1016/j.jamda.2017.05.023. Epub 2017 Jul 1.
Examine the association between completion of an outpatient visit with a physician or advanced practice provider (PCP) within 7 days of discharge from a short skilled nursing facility (SNF) stay and 30-day readmission and determine if functional status at discharge moderates visit effectiveness.
Retrospective cohort study.
Large integrated health care system.
Adults 65 years and older, discharged home from a short SNF stay (n = 4073).
None.
Exposure is completion of an outpatient visit with a PCP within 7 days of discharge from an SNF. Primary outcome is readmission within 30 days of SNF discharge. Covariates included gender, risk score for readmission or early death, medical or surgical hospitalization, SNF facility, SNF length of stay, SNF stay in the previous 12 months, discharge to home or home health, and discharge functional independence measures (FIM).
A total of 476 (11.6%) patients were readmitted within 30 days of SNF discharge. Patients who completed an outpatient visit with a PCP within 7 days of SNF discharge had a 23% higher risk of being readmitted compared to patients who did not complete any visit (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.01-1.50). Patients who had FIM scores ≥80 and completed a visit had an increased readmission risk (HR 1.37, 95% CI 1.04-1.79); the increased risk was not seen for those with worse functional impairment, FIM <80 (HR 1.11, 95% CI 0.85-1.46).
The finding of increased risk of readmission post SNF discharge with completion of an outpatient visit likely reflects inadequate adjustment for selection bias in this observational study, which strongly argues for the need to design prospective studies to test transitional care services post SNF discharge.
考察在短期熟练护理机构（SNF）出院后 7 天内完成与医生或高级实践提供者（PCP）的门诊就诊与 30 天再入院之间的关系，并确定出院时的功能状态是否调节就诊效果。
回顾性队列研究。
大型综合医疗保健系统。
年龄在 65 岁及以上，从短期 SNF 出院后（n=4073）返回家中的成年人。
无。
暴露因素是在 SNF 出院后 7 天内完成与 PCP 的门诊就诊。主要结果是 SNF 出院后 30 天内再入院。协变量包括性别、再入院或早期死亡风险评分、医疗或手术住院、SNF 机构、SNF 住院时间、SNF 前 12 个月住院、出院至家庭或家庭保健以及出院功能独立性测量（FIM）。
共有 476 名（11.6%）患者在 SNF 出院后 30 天内再次入院。与未完成任何就诊的患者相比，在 SNF 出院后 7 天内完成 PCP 门诊就诊的患者再入院的风险高 23%（风险比[HR]1.23，95%置信区间[CI]1.01-1.50）。FIM 评分≥80 并完成就诊的患者再入院风险增加（HR 1.37，95%CI 1.04-1.79）；对于功能障碍更严重的患者，FIM<80（HR 1.11，95%CI 0.85-1.46），则未观察到风险增加。
在 SNF 出院后完成门诊就诊与再入院风险增加的发现可能反映了在这项观察性研究中选择偏差的调整不足，这强烈要求设计前瞻性研究来测试 SNF 出院后的过渡性护理服务。
