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基层医疗实践中跨专业出院诊所的服务描述与分析

Service description and analysis for an interprofessional discharge clinic within a primary care practice.

作者信息

Yu Joyce, Pincus Kathleen, Mattingly T Joseph

机构信息

a University of Maryland , Baltimore School of Pharmacy , Baltimore , Maryland , USA.

b University of Maryland , Baltimore School of Pharmacy, Department of Pharmacy Practice and Sciences , Baltimore , Maryland , USA.

出版信息

J Interprof Care. 2017 Nov;31(6):771-773. doi: 10.1080/13561820.2017.1347611. Epub 2017 Sep 28.

DOI:10.1080/13561820.2017.1347611
PMID:28956674
Abstract

At care transitions, patients are susceptible to adverse events and medication errors that can lead to harm or hospital readmission. This study describes the services provided by an interprofessional discharge clinic (IDC) aimed to improve these transitions and the impact on 30-day readmission rate, medication errors, and interventions documented. Data were collected retrospectively using an electronic medical record and analysed using SAS data system. Among 167 discharged patients, 154 patients were seen by a physician only (PO) and 13 patients were seen in the IDC. Thirty-day readmission rates were 26.6% and 7.7% for patients in the PO and IDC groups, respectively (p = 0.19). Seventy patients (45.5%) in the PO group and 11 patients (84.6%) in the IDC group (p = 0.0082) were found to have at least one medication error. All patients seen at the IDC had an intervention made, while 68 (44.2%) seen by a PO received no intervention (p = 0.0009). While sample size was a major limitation, a statistically significant increase in identified medication errors and intervention documentation was found in the IDC group. It is critical that healthcare systems continue to develop new strategies, such as IDCs, to reduce hospital readmissions.

摘要

在护理转接过程中,患者容易发生不良事件和用药错误,进而可能导致伤害或再次入院。本研究描述了一个跨专业出院诊所(IDC)提供的服务,该服务旨在改善这些转接过程,并阐述了其对30天再入院率、用药错误以及记录的干预措施的影响。使用电子病历进行回顾性数据收集,并使用SAS数据系统进行分析。在167名出院患者中,仅由医生诊治(PO)的患者有154名,在IDC就诊的患者有13名。PO组和IDC组患者的30天再入院率分别为26.6%和7.7%(p = 0.19)。在PO组中,70名患者(45.5%)存在至少一处用药错误,在IDC组中,11名患者(84.6%)存在至少一处用药错误(p = 0.0082)。在IDC就诊的所有患者均接受了干预措施,而在PO组中,68名接受诊治的患者(44.2%)未接受任何干预(p = 0.0009)。尽管样本量是一个主要限制因素,但在IDC组中发现,已识别的用药错误和干预记录在统计学上有显著增加。医疗保健系统继续制定诸如IDC之类的新策略以降低医院再入院率至关重要。

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