Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, Pennsylvania.
Center for Family and Community Medicine, Colombia University New York City, New York, New York.
Popul Health Manag. 2020 Feb;23(1):47-52. doi: 10.1089/pop.2019.0014. Epub 2019 May 20.
Patients who are admitted to the hospital frequently (>3 admissions in a 6-month period) are a large driver of health care costs. Recently, research has focused on these groups of super-utilizing patients to try to find ways to meet their care needs in the outpatient setting. However, most research so far has focused on the urban underserved population who do not have a usual source of care. The goal of this study is to identify a group of patients from a suburban academic family medicine practice who have been admitted to the hospital frequently over a 6-month period and interview them to identify patient-perceived barriers to care in the outpatient setting. Nine of the 176 patients identified as frequently hospitalized were interviewed. Interpretive phenomenology analysis was used to identify perceived barriers and facilitators to care. Although some identified barriers were similar to those noted in groups of the urban underserved, including chronic disease and polypharmacy, other barriers were uniquely identified in the nonurban population, including transportation and support at home. Transportation issues, lack of support at home, and poor interdisciplinary communication were found to increase risk for readmission. Conversely, good interdisciplinary communication and ample support from family, including support services at home, were viewed as facilitators to outpatient care.
经常住院的患者（在 6 个月内住院 3 次以上）是医疗保健费用的主要驱动因素。最近，研究的重点是这些过度使用医疗服务的患者群体，试图找到在门诊环境中满足他们医疗需求的方法。然而，到目前为止，大多数研究都集中在没有常规医疗服务来源的城市服务不足人群。本研究的目的是确定一个在郊区学术家庭医学实践中经常住院的患者群体，并对他们进行访谈，以确定患者在门诊环境中对医疗的感知障碍。从 176 名被确定为经常住院的患者中选取了 9 名进行访谈。采用解释性现象学分析来确定护理的感知障碍和促进因素。尽管一些已确定的障碍与城市服务不足群体中注意到的障碍相似，包括慢性疾病和多种药物治疗，但在非城市人群中还发现了其他独特的障碍，包括交通和家庭支持。研究发现，交通问题、家庭支持不足以及跨学科沟通不畅会增加再次入院的风险。相反，良好的跨学科沟通和家庭的充分支持，包括家庭支持服务，被视为门诊护理的促进因素。
