Adelphi University College of Nursing and Public Health, Garden City, NY.
Columbia University School of Nursing, New York, NY.
Am J Infect Control. 2019 Jul;47(7):786-792.e1. doi: 10.1016/j.ajic.2018.12.012. Epub 2019 Feb 14.
Urinary tract infection (UTI)- related hospitalizations are a poor patient outcome in the rapidly growing home health care (HHC) arena that serves a predominantly elderly population. We examined the association between activities of daily living (ADL) and risk of UTI-related hospitalization among this population.
Using a retrospective cohort design, we conducted a secondary data analysis of a 5% random sample of a national HHC dataset, the Outcome and Assessment Information Set for the year 2013. Andersen's Behavioral Model of Health Service Utilization was used as a guiding framework for statistical modeling. We used logistic regression to examine the association between UTI-related hospitalization and predisposing, enabling, or need factors.
Among beneficiaries (n = 24,887) hospitalized in 2013, 1,133 had UTI-related hospitalizations. HHC patients with a UTI-related hospitalization were more likely to have severe ADL dependency, impaired decision making, and lower Charlson Comorbidity Index, than those with a non UTI-related hospitalization (P < .001). Risk factors for UTI-related hospitalization included female sex, (adjusted odds ratio [AOR], 1.44; 95% confidence interval [CI], 1.25-1.66), Medicaid recipient (AOR, 1.99; 95% CI, 1.09-3.64), severe ADL dependency (AOR, 1.50; 95% CI, 1.16-1.94), the presence of a caregiver to assist with supervision and safety (AOR, 1.26; 95% CI, 1.06-1.49), treatment for UTI in the previous 14 days (AOR, 2.85; 95% CI, 2.46-3.29), presence of a urinary catheter (AOR, 3.77; 95% CI, 2.98-4.77), and prior history of indwelling or suprapubic catheter (AOR, 1.44; 95% CI, 1.06-1.94).
ADL dependency levels are a potentially modifiable risk factor for UTI-related hospitalization on admission to HHC. ADL dependency levels can inform clinical interventions to ameliorate ADL dependency in HHC settings and identify groups of patients at high risk for UTI-related hospitalization.
在快速发展的家庭保健（HHC）领域中，与尿路感染（UTI）相关的住院治疗是患者预后不良的表现，而该领域主要服务于老年人群。我们研究了该人群的日常生活活动（ADL）与 UTI 相关住院风险之间的关系。
使用回顾性队列设计，我们对全国 HHC 数据集 Outcome and Assessment Information Set 2013 年的 5%随机样本进行了二次数据分析。安德森卫生服务利用行为模型被用作统计建模的指导框架。我们使用逻辑回归来检查 UTI 相关住院治疗与易感性、赋权或需求因素之间的关联。
在 2013 年住院的受益人群（n=24887）中，有 1133 人发生了 UTI 相关的住院治疗。与非 UTI 相关住院治疗相比，发生 UTI 相关住院治疗的 HHC 患者更有可能存在严重的 ADL 依赖、决策能力受损和较低的 Charlson 合并症指数（P<0.001）。UTI 相关住院治疗的风险因素包括女性（调整后优势比[OR]，1.44；95%置信区间[CI]，1.25-1.66）、医疗补助计划（Medicaid）受助人（OR，1.99；95% CI，1.09-3.64）、严重的 ADL 依赖（OR，1.50；95% CI，1.16-1.94）、有护理人员协助监督和安全（OR，1.26；95% CI，1.06-1.49）、在过去 14 天内接受过 UTI 治疗（OR，2.85；95% CI，2.46-3.29）、存在导尿管（OR，3.77；95% CI，2.98-4.77）和留置或耻骨上导尿管的既往史（OR，1.44；95% CI，1.06-1.94）。
ADL 依赖程度是 HHC 入院时与 UTI 相关住院治疗相关的潜在可改变的风险因素。ADL 依赖程度可以为临床干预提供信息，以改善 HHC 环境中的 ADL 依赖程度，并确定易发生 UTI 相关住院治疗的高风险人群。
