预测急性后期护理出院后30天再入院的风险因素。

Predicting Risk Factors for 30-Day Readmissions Following Discharge From Post-Acute Care.

作者信息

Flanagan Nina M, Rizzo Victoria M, James Gary D, Spegman Adele, Barnawi Najla A

机构信息

Nina M. Flanagan, PhD, GNP, is Assistant Professor, Decker School of Nursing, Binghamton University. Her research focus is on the role of nursing in the management of older adults with cognitive impairment and medical comorbidities. Victoria M. Rizzo, PhD, LCSW-R, is Department Chair and Associate Professor, Department of Social Work, Binghamton University. Her research examines the impact of interprofessional interventions including social workers on older adults coping with chronic illnesses and the implications of health care policy and financing on the provision of these services to older adults. Gary D. James, is Director of the Biomedical Anthropology Program, Director of the Institute for Primary and Preventative Health Care, and Professor of Anthropology, Nursing, and Biomedical Engineering at Binghamton University. He is a fellow of the Society of Behavioral Medicine and AAAS and a member of the Harvey Society. Adele Spegman, PhD, RN, is Director of Nursing Research for the Geisinger Health System in Pennsylvania. Her current studies focus on pain management and nurses' work environment. Dr. Spegman holds degrees from Oregon Health and Science University, University of Minnesota, and Niagara University. Najla A. Barnawi, MS, RN, is PhD candidate at Decker School of Nursing, Binghamton University. She started her career as a clinical instructor in a private diploma nursing institution for one full year. In 2003, she worked as Teaching Assistant at King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) mainly in maternity and community nursing care.

出版信息

Prof Case Manag. 2018 May/Jun;23(3):139-146. doi: 10.1097/NCM.0000000000000261.

DOI:10.1097/NCM.0000000000000261

PMID:29601425

Abstract

PURPOSE OF STUDY

The specific aims of this descriptive study were to (1) examine the relationships between individual-level determinants of health using standard care admission assessments of residents admitted to a skilled nursing facility (SNF) and those residents readmitted to the hospital within 30 days from discharge from the same SNF; (2) identify and describe the risk factors of the residents readmitted to the hospital within 30 days; and (3) use the findings to inform and refine current practice to target the mutable risk factors correlated with 30-day hospital readmission.

PRIMARY PRACTICE SETTING

A 180-bed skilled nursing center in Northeastern Pennsylvania.

METHODOLOGY AND SAMPLE

A retrospective paper medical record review of patients discharged from an SNF to community living was conducted to examine the relationship between individual determinants of health behaviors and 30-day hospital readmissions. The study sample (N = 221) included adults 65 years and older who were admitted to the SNF from January to December 2014 for subacute physical rehabilitation following an acute care hospital stay with a discharge plan to community living.

RESULTS

The 30-day readmission rate was 11%. The results of the logistic regression including diagnosis at readmission showed that the odds of readmission before 30 days were nearly three times greater in patients who had congestive heart failure (p < .02). Patients who were at "very high risk" on the Braden Scale were 20 times more likely to be readmitted before 30 days compared with those at low risk. Age and gender were not predictors. None of the other standard screening assessments for delirium, depression, functional status, and fall risk were predictive of 30-day readmission.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

(1) Care coordination and communication with residents, caregivers, and home health can have an impact on 30-day readmissions post-SNF discharge. (2) Chronic respiratory diseases continue to be a challenge in prevention of hospital readmissions.

摘要

研究目的

本描述性研究的具体目标是：（1）使用对入住专业护理机构（SNF）的居民进行的标准护理入院评估，研究个体健康决定因素与那些从同一SNF出院后30天内再次入院的居民之间的关系；（2）识别并描述在30天内再次入院的居民的风险因素；（3）利用研究结果为当前实践提供信息并加以完善，以针对与30天内再次入院相关的可变风险因素。

主要实践场所

宾夕法尼亚州东北部一家拥有180张床位的专业护理中心。

方法与样本

对从SNF出院至社区生活的患者进行回顾性纸质病历审查，以研究健康行为的个体决定因素与30天内再次入院之间的关系。研究样本（N = 221）包括2014年1月至12月入住SNF进行亚急性身体康复的65岁及以上成年人，他们在急性护理医院住院后出院计划为社区生活。

结果

30天再次入院率为11%。包括再次入院时诊断在内的逻辑回归结果显示，患有充血性心力衰竭的患者在30天前再次入院的几率几乎高出近三倍（p <.02）。在Braden量表上处于“极高风险”的患者在30天前再次入院的可能性是低风险患者的20倍。年龄和性别不是预测因素。谵妄、抑郁、功能状态和跌倒风险的其他标准筛查评估均不能预测30天再次入院。