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药师主导的干预对 30 天再入院的影响及对心力衰竭的非裔美国男性再入院预测因素的评估。

Impact of a Pharmacist-Led Intervention on 30-Day Readmission and Assessment of Factors Predictive of Readmission in African American Men With Heart Failure.

机构信息

1 Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University, Atlanta, GA, USA.

2 Department of Pharmacy Practice, College of Pharmacy, Mercer University, Atlanta, GA, USA.

出版信息

Am J Mens Health. 2019 Jan-Feb;13(1):1557988318814295. doi: 10.1177/1557988318814295. Epub 2018 Nov 28.

Abstract

Heart failure (HF) is responsible for more 30-day readmissions than any other condition. Minorities, particularly African American males (AAM), are at much higher risk for readmission than the general population. In this study, demographic, social, and clinical data were collected from the electronic medical records of 132 AAM patients (control and intervention) admitted with a primary or secondary admission diagnosis of HF. Both groups received guideline-directed therapy for HF. Additionally the intervention group received a pharmacist-led intervention. Data collected from these patients were used to develop and validate a predictive model to evaluate the impact of the pharmacist-led intervention, and identify predictors of readmission in this population. After propensity score matching, the intervention was determined to have a significant impact on readmission, as a significantly smaller proportion of patients in the intervention group were readmitted as compared to the control group (11.5% vs. 42.9%; p = .03). A predictive model for 30-day readmission was developed using K-nearest neighbor (KNN) classification algorithm. The model was able to correctly classify about 71% patients with an AUROC of 0.70. Additionally, the model provided a set of key patient attributes predictive of readmission status. Among these predictive attributes was whether or not a patient received the intervention. A relative risk analysis identified that patients who received the intervention are less likely to be readmitted within 30 days. This study demonstrated the benefit of a pharmacist-led intervention for AAM with HF. Such interventions have the potential to improve quality of life for this patient population.

摘要

心力衰竭(HF)导致的 30 天再入院率高于其他任何疾病。少数民族,尤其是非裔美国男性(AAM),再入院的风险远高于一般人群。在这项研究中,从 132 名 AAM 患者(对照组和干预组)的电子病历中收集了人口统计学、社会和临床数据,这些患者因原发性或继发性 HF 入院。两组均接受了 HF 指南导向的治疗。此外,干预组还接受了药剂师主导的干预。从这些患者收集的数据用于开发和验证预测模型,以评估药剂师主导的干预的影响,并确定该人群再入院的预测因素。经过倾向评分匹配后,干预措施对再入院有显著影响,因为干预组的再入院患者比例明显低于对照组(11.5% vs. 42.9%;p =.03)。使用 K-最近邻(KNN)分类算法开发了 30 天再入院预测模型。该模型能够正确分类约 71%的患者,AUROC 为 0.70。此外,该模型提供了一组预测再入院状态的关键患者特征。在这些预测特征中,是否接受了干预。相对风险分析确定,接受干预的患者在 30 天内再入院的可能性较低。这项研究证明了药剂师主导的干预对 HF 的 AAM 的益处。此类干预有可能改善这一患者群体的生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aff8/6775676/abc82ebbb31d/10.1177_1557988318814295-fig1.jpg

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