Wilson J Deanna, Shaw Katherine Clair, Feldman Leonard Samuel
J Health Care Poor Underserved. 2018;29(4):1288-1299. doi: 10.1353/hpu.2018.0096.
Patient-centered discharge planning improves transitional care and health outcomes for vulnerable adults. The HOME Initiative was an educational intervention aiming to improve trainees' patient-centered discharge planning skills.
Using a quasi-experimental design, 52 internal medicine residents at an academic medical center were randomized to intervention or control in 2014-2015. Intervention interns visited recently discharged patients during inpatient rotations. Interns addressed patient deficits in understanding, rectified medication errors, and provided health education.
Over three-quarters (77%) of intervention interns completed pre-and post-tests. Intervention interns reported significant improvements in patient-centered discharge planning skills and delivery of culturally sensitive care. Through improved communication skills, residents more effectively elicited patients' illness narratives and assessed their patients' safety (0.65; p=.05), functional status (0.79; p=.02) and health literacy (0.70; p=.01).
Structured home visitation with recently discharged patients is a valuable tool for medical residents to learn patient-centered discharge planning and improve delivery of culturally sensitive care.
以患者为中心的出院计划可改善弱势成年人的过渡性护理和健康结局。“居家倡议”是一项教育干预措施，旨在提高实习生以患者为中心的出院计划技能。
采用准实验设计，2014 - 2015年将某学术医学中心的52名内科住院医师随机分为干预组或对照组。干预组实习生在住院轮转期间探访近期出院的患者。实习生解决患者在理解方面的不足，纠正用药错误，并提供健康教育。
超过四分之三（77%）的干预组实习生完成了前后测试。干预组实习生报告称，以患者为中心的出院计划技能以及提供具有文化敏感性的护理方面有显著改善。通过提高沟通技巧，住院医师能更有效地引出患者的病情叙述，并评估患者的安全状况（0.65；p = 0.05）、功能状态（0.79；p = 0.02）和健康素养（0.70；p = 0.01）。
对近期出院的患者进行结构化的家访是医学住院医师学习以患者为中心的出院计划并改善提供具有文化敏感性护理的一项宝贵工具。
