Department of Emergency Medicine, University of Washington, Seattle, WA.
Center for Scholarship in Patient Care Quality and Safety, University of Washington, Seattle, WA.
Acad Emerg Med. 2019 Jun;26(6):605-609. doi: 10.1111/acem.13623. Epub 2019 May 23.
Recent attention has been given to developing measures to capture the quality of ED transitions of care. We examined the utility of a patient-reported measure of transitional care, the Care Transitions Measure-3 (CTM-3), in the ED setting and its association with outcomes of care after ED discharge.
A telephone survey was conducted of a convenience sample of patients 14 days after discharge from two emergency departments (EDs) in an academic health system. Patients responded to three statements using a four-point agreement scale (strongly disagree, disagree, agree, strongly agree): 1) "The hospital staff took my preferences and those of my family or caregiver into account when deciding what my health care needs would be"; 2) " When I left the ER, I had a good understanding of the things I was responsible for in managing my health"; and 3) "When I left the hospital, I clearly understood the purpose for taking each of my medications." Patients were also queried about outcomes after ED discharge that are known to be related to ED care transitions including medication adherence, completion of recommended follow-up, and return visits to the ED. Multivariable logistic regression was used to determine the association between the CTM-3 score (on a 100-point scale) and outcomes of interest.
Among 1,832 patients called, 576 were reached by phone, and 410 consented and completed our survey, representing a 22.4% response rate of patients we attempted to call. A 10-point increase in the CTM-3 score (better care experiences) was associated with a 12% decrease in the odds of having an ED return visit (adjusted odds ratio [AOR] = 0.88, 95% confidence interval [CI] = 0.77-1.00) and a 45% increase in the odds of taking prescribed medications as recommended (AOR = 1.45, 95% CI = 1.12-1.87). There was no association between CTM-3 score and completion of follow-up.
The CTM-3 is associated with outcomes of care after an ED visit, including ED return visits and medication adherence, and may have utility as a patient-reported measure of ED transitions of care.
最近，人们越来越关注开发衡量急诊过渡护理质量的措施。我们研究了一种患者报告的过渡护理衡量工具，即过渡护理衡量-3 版（CTM-3）在急诊环境中的效用，以及其与急诊出院后护理结局的关系。
在一个学术医疗系统的两家急诊部，对出院后 14 天的便利样本患者进行了电话调查。患者使用四点同意量表（非常不同意、不同意、同意、非常同意）对三个陈述进行了回答：1）“当决定我的医疗需求时，医院工作人员考虑了我的个人偏好以及我的家人或护理人员的偏好”；2）“当我离开急诊室时，我非常了解我负责管理自己健康的事情”；3）“当我离开医院时，我清楚地了解我服用每种药物的目的。”还询问了患者出院后与急诊护理过渡相关的已知结局，包括药物依从性、完成推荐的随访以及再次就诊急诊。使用多变量逻辑回归来确定 CTM-3 评分（百分制）与感兴趣的结局之间的关联。
在联系的 1832 名患者中，有 576 名患者通过电话联系上，其中 410 名患者同意并完成了我们的调查，这代表了我们试图联系的患者的 22.4%的应答率。CTM-3 评分每增加 10 分（护理体验更好），急诊再次就诊的几率就会降低 12%（调整后的优势比 [AOR] = 0.88，95%置信区间 [CI] = 0.77-1.00），而遵医嘱服药的几率会增加 45%（AOR = 1.45，95% CI = 1.12-1.87）。CTM-3 评分与完成随访之间没有关联。
CTM-3 与急诊就诊后的护理结局相关，包括急诊再次就诊和药物依从性，并且可能作为急诊过渡护理的患者报告衡量工具具有一定的效用。
