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预测患者对住院原因的理解。

Predictors for patients understanding reason for hospitalization.

机构信息

Department of Medicine, NYU School of Medicine, New York, NY, United States of America.

Department of Population Health, NYU School of Medicine, New York, New York, United States of America.

出版信息

PLoS One. 2018 Apr 27;13(4):e0196479. doi: 10.1371/journal.pone.0196479. eCollection 2018.

DOI:10.1371/journal.pone.0196479
PMID:29702676
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5922555/
Abstract

OBJECTIVE

To examine predictors for understanding reason for hospitalization.

METHODS

This was a retrospective analysis of a prospective, observational cohort study of patients 65 years or older admitted for acute coronary syndrome, heart failure, or pneumonia and discharged home. Primary outcome was complete understanding of diagnosis, based on post-discharge patient interview. Predictors assessed were the following: jargon on discharge instructions, type of medical team, whether outpatient provider knew if the patient was admitted, and whether the patient reported more than one day notice before discharge.

RESULTS

Among 377 patients, 59.8% of patients completely understood their diagnosis. Bivariate analyses demonstrated that outpatient provider being aware of admission and having more than a day notice prior to discharge were not associated with patient understanding diagnosis. Presence of jargon was not associated with increased likelihood of understanding in a multivariable analysis. Patients on housestaff and cardiology teams were more likely to understand diagnosis compared to non-teaching teams (OR 2.45, 95% CI 1.30-4.61, p<0.01 and OR 3.83, 95% CI 1.92-7.63, p<0.01, respectively).

CONCLUSIONS

Non-teaching team patients were less likely to understand their diagnosis. Further investigation of how provider-patient interaction differs among teams may aid in development of tools to improve hospital to community transitions.

摘要

目的

探讨影响患者对住院原因理解的预测因素。

方法

本研究为前瞻性观察队列研究的回顾性分析,纳入年龄≥65 岁因急性冠脉综合征、心力衰竭或肺炎住院并出院回家的患者。主要结局是通过出院后患者访谈确定患者对诊断的完全理解。评估的预测因素如下:出院医嘱中的术语、医疗团队的类型、门诊医生是否了解患者住院情况,以及患者在出院前是否提前通知超过一天。

结果

在 377 名患者中,有 59.8%的患者完全理解他们的诊断。单变量分析表明,门诊医生了解患者住院情况以及患者在出院前提前通知超过一天与患者理解诊断之间无相关性。在多变量分析中,术语的存在与理解诊断的可能性增加无关。与非教学团队相比,主治医生团队和心脏病学团队的患者更有可能理解诊断(OR 2.45,95% CI 1.30-4.61,p<0.01 和 OR 3.83,95% CI 1.92-7.63,p<0.01)。

结论

非教学团队的患者更有可能不理解他们的诊断。进一步研究不同团队中医患互动的差异可能有助于开发改善医院到社区过渡的工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2301/5922555/6a2869def659/pone.0196479.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2301/5922555/6a2869def659/pone.0196479.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2301/5922555/6a2869def659/pone.0196479.g001.jpg

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本文引用的文献

1
Quality of discharge practices and patient understanding at an academic medical center.学术医疗中心的出院实践质量和患者理解度。
JAMA Intern Med. 2013 Oct 14;173(18):1715-22. doi: 10.1001/jamainternmed.2013.9318.
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Medication reconciliation accuracy and patient understanding of intended medication changes on hospital discharge.患者出院时药物重整准确性及对预期药物变更的理解。
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Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study.医院医生护理与出院后医疗利用的关联:来自队列研究的成本转移证据。
Ann Intern Med. 2011 Aug 2;155(3):152-9. doi: 10.7326/0003-4819-155-3-201108020-00005.
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Association of care by hospitalists on discharge destination and 30-day outcomes after acute ischemic stroke.急性缺血性脑卒中出院去向和 30 天结局的医院医师照护相关性研究。
Med Care. 2011 Aug;49(8):701-7. doi: 10.1097/MLR.0b013e3182166cb6.
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Do hospitalists affect clinical outcomes and efficiency for patients with acute upper gastrointestinal hemorrhage (UGIH)?内科住院医师是否会影响急性上消化道出血(UGIH)患者的临床结局和效率?
J Hosp Med. 2010 Mar;5(3):133-9. doi: 10.1002/jhm.612.
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N Engl J Med. 2009 Apr 2;360(14):1418-28. doi: 10.1056/NEJMsa0803563.
8
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J Hosp Med. 2007 Sep;2(5):314-23. doi: 10.1002/jhm.228.
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Teaching about health literacy and clear communication.关于健康素养和清晰沟通的教学。
J Gen Intern Med. 2006 Aug;21(8):888-90. doi: 10.1111/j.1525-1497.2006.00543.x.
10
Patients' understanding of their treatment plans and diagnosis at discharge.患者在出院时对其治疗方案和诊断的理解。
Mayo Clin Proc. 2005 Aug;80(8):991-4. doi: 10.4065/80.8.991.