Clancy Una, Brown Mark, Alio Ziad, Wardle Kate, Pendleton Neil
Western General Hospital, Edinburgh, UK.
Salford Royal Foundation Trust, Salford, UK.
Future Healthc J. 2018 Feb;5(1):58-63. doi: 10.7861/futurehosp.5-1-58.
Following surgery for hip fracture almost a quarter of patients do not return directly to their usual residence, using the resources within intermediate care and enablement. This was a retrospective cohort study involving 156 Salford residents admitted with hip fracture in 2015. Linked health data were collected on those discharged to intermediate care vs home in terms of readmissions, mortality, lengths of stay, delayed transfers of care, diagnoses of delirium and pre-existing forms of dementia. The median duration of the continuous care episode in the intermediate care cohort, inclusive of readmissions to hospital, was 52 days. There was a 26% (n=20) readmission rate from intermediate care. Readmission rates at 120 days were higher among those discharged to intermediate care vs home (OR 3.21, 95% CI 1.37-7.54, p=0.007) and among those with a form of dementia (OR 4.76, 95% CI 1.79-12.63, p=0.0017). Patients with delirium during their acute admission were more likely to be discharged to intermediate care (OR 5.43, 95% CI 2.36-12.47, p=0.0001) and were less likely to ultimately be discharged home (OR 6.40, 95% CI 2.25-18.21, p=0.0005), as were those with some form of dementia (OR 6.60, 95% CI 1.97-22.08, p=0.002). Measurement of the entire care episode demonstrates significant lengths of stay. Medium term readmission rates are higher in those discharged to intermediate care. Delirium and dementia are associated with higher readmission rates and lower rates of discharge to own home. It is imperative that a whole pathway approach to commissioning hip fracture services is established.
髋部骨折手术后，近四分之一的患者没有直接回到他们通常的住所，而是使用了中级护理和支持服务中的资源。这是一项回顾性队列研究，涉及2015年因髋部骨折入院的156名索尔福德居民。收集了出院至中级护理机构与回家的患者的相关健康数据，包括再入院情况、死亡率、住院时间、护理延迟转移、谵妄诊断和既往痴呆形式。中级护理队列中连续护理事件的中位持续时间，包括再次入院至医院，为52天。中级护理机构的再入院率为26%（n = 20）。出院至中级护理机构的患者在120天时的再入院率高于回家的患者（比值比3.21，95%置信区间1.37 - 7.54，p = 0.007），患有某种痴呆形式的患者也是如此（比值比4.76，95%置信区间1.79 - 12.63，p = 0.0017）。急性入院期间发生谵妄的患者更有可能出院至中级护理机构（比值比5.43，95%置信区间2.36 - 12.47，p = 0.0001），最终出院回家的可能性较小（比值比6.40，95%置信区间2.25 - 18.21，p = 0.0005），患有某种痴呆形式的患者也是如此（比值比6.60，95%置信区间1.97 - 22.08，p = 0.002）。对整个护理事件的测量显示住院时间显著延长。出院至中级护理机构的患者中期再入院率较高。谵妄和痴呆与较高的再入院率以及较低的回家出院率相关。必须建立一种全面的髋部骨折服务委托途径。
