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.
PLoS One. 2018 Apr 27;13(4):e0196479. doi: 10.1371/journal.pone.0196479. eCollection 2018.
To examine predictors for understanding reason for hospitalization.
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.
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).
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.
探讨影响患者对住院原因理解的预测因素。
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。
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)。
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。