Gilmore-Bykovskyi Andrea L, Kennelty Korey A, DuGoff Eva, Kind Amy J H
University of Wisconsin-Madison School of Nursing, 701 Highland Ave, Madison, WI, 53705, USA.
Department of Medicine, Division of Geriatrics, University of Wisconsin-Madison School of Medicine & Public Health, 750 Highland Ave, Madison, WI, 53726, USA.
BMC Health Serv Res. 2018 Feb 9;18(1):103. doi: 10.1186/s12913-018-2907-2.
Transitions to sub-acute care are regularly complicated by inadequate discharge communication, which is exacerbated by a lack of clarity regarding accountability for important follow-up care. Patients discharged to sub-acute care often have complex medical conditions and are at heightened risk for poor post-hospital outcomes, yet many do not see a provider until 30 days post discharge due to current standards in Medicare regulations. Lack of designation of a responsible clinician or clinic for follow-up care may adversely impact patient outcomes, but the magnitude of this potential impact has not been previously studied.
We examined the association of designating a responsible clinician/clinic for post-hospital follow-up care within the hospital discharge summary on risk for 30-day rehospitalization and/or death in stroke and hip fracture patients discharged to sub-acute care. This retrospective cohort study used Medicare Claims and Electronic Health Record data to identify non-hospice Medicare beneficiaries with primary discharge diagnoses of stroke/ or hip fracture discharged from one of two urban hospitals to sub-acute care facilities during 2003-2008 (N = 1130). We evaluated the association of omission of the designation of a responsible clinician/clinic for follow-up care in the hospital discharge summary on the composite outcome of 30-day rehospitalization and/or death after adjusting for patient characteristics and utilization. We used multivariate logistic regression robust estimates clustered by discharging hospital.
Patients whose discharge summaries omitted designation of a responsible clinician/clinic for follow-up care were significantly more likely to experience 30-day rehospitalization and/or death (OR: 1.51, 95% CI 1.07-2.12, P = 0.014).
The current study found a strong relationship between the omission of a responsible clinician/clinic for follow-up care from the hospital discharge summary and the poor outcomes for patients transferred to sub-acute care. More research is needed to understand the role and impact of designating accountability for follow-up care needs on patient outcomes.
向亚急性护理的过渡常常因出院沟通不足而变得复杂，而对于重要后续护理责任的不明确又加剧了这一问题。转入亚急性护理的患者通常患有复杂的医疗状况，且出院后预后不良的风险较高，但由于医疗保险法规的现行标准，许多患者在出院后30天内都见不到医护人员。缺乏指定负责后续护理的临床医生或诊所可能会对患者的预后产生不利影响，但这种潜在影响的程度此前尚未得到研究。
我们研究了在出院小结中指定负责出院后随访护理的临床医生/诊所与转入亚急性护理的中风和髋部骨折患者30天再住院和/或死亡风险之间的关联。这项回顾性队列研究使用医疗保险索赔和电子健康记录数据，识别2003年至2008年期间从两家城市医院之一出院并转入亚急性护理机构、主要出院诊断为中风或髋部骨折的非临终关怀医疗保险受益人（N = 1130）。在调整患者特征和医疗服务利用情况后，我们评估了出院小结中遗漏指定负责随访护理的临床医生/诊所在30天再住院和/或死亡这一综合结局方面的关联。我们使用了按出院医院聚类的多变量逻辑回归稳健估计。
出院小结中遗漏指定负责随访护理的临床医生/诊所的患者，30天再住院和/或死亡的可能性显著更高（比值比：1.51，95%置信区间1.07 - 2.12，P = 0.014）。
当前研究发现，出院小结中遗漏负责随访护理的临床医生/诊所与转入亚急性护理患者的不良预后之间存在密切关系。需要更多研究来了解指定随访护理责任对患者预后的作用和影响。
