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住院医师出院后电话随访对患者满意度及再入院率改善效果的回顾性分析

Retrospective Analysis of the Effect of Postdischarge Telephone Calls by Hospitalists on Improvement of Patient Satisfaction and Readmission Rates.

作者信息

Xiao Mengli, St Hill Catherine A, Vacquier Marc, Patel Love, Mink Pamela, Fernstrom Karl, Kirven Justin, Jeruzal Jessica, Beddow David

机构信息

From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota.

出版信息

South Med J. 2019 Jul;112(7):357-362. doi: 10.14423/SMJ.0000000000000994.

Abstract

OBJECTIVES

The influence of postdischarge telephone call interventions preventing hospital readmissions is unclear. A novel approach of the discharging hospitalist providing this intervention may improve overall patient satisfaction. Our objective was to assess the impact of postdischarge telephone calls from discharging hospitalists on readmissions and patients' ratings of hospital care and hospitalist communication.

METHODS

Data were retrospectively collected from patients' electronic health records at a 167-bed hospital in Fridley, Minnesota and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients were 18 years old or older and diagnosed as having nonpsychiatric conditions. Telephone calls were made by the discharging hospitalist to adult patients discharged to home with or without home care services between February 28, 2015 and February 29, 2016. Multivariate logistic regression models were used to evaluate associations of postdischarge telephone calls with global hospital care rating and hospitalist communication from HCAHPS, and 30-day readmission rates from electronic health records.

RESULTS

Of 4490 eligible patients, 1067 had completed telephone calls (23.8%). The intervention was associated with a statistically significant improvement in the responses to HCAHPS overall hospital rating and HCAHPS doctor communication questions (adjusted odds ratio 1.52, = 0.04 and adjusted odds ratio 1.56, = 0.021) that varied by patient age at first admission ( = 0.001 and = 0.101). With longer inpatient lengths of stay, 30-day readmission rates improved after patients received a postdischarge telephone call, but this outcome was not statistically significant.

CONCLUSIONS

This study revealed that postdischarge telephone calls from discharging hospitalists increased patient satisfaction. Further research is needed to understand the causal relationships among the intervention, 30-day hospital readmission rates, and inpatient length of stay.

摘要

目的

出院后电话干预对预防医院再入院的影响尚不清楚。由负责出院的住院医师进行这种干预的新方法可能会提高患者总体满意度。我们的目的是评估负责出院的住院医师进行的出院后电话随访对再入院率以及患者对医院护理和住院医师沟通的评分的影响。

方法

从明尼苏达州弗里德利市一家拥有167张床位的医院的患者电子健康记录以及医疗服务提供者和系统的医院消费者评估(HCAHPS)调查中回顾性收集数据。患者年龄在18岁及以上,被诊断患有非精神疾病。在2015年2月28日至2016年2月29日期间,负责出院的住院医师对出院回家的成年患者进行电话随访,这些患者接受或未接受家庭护理服务。使用多变量逻辑回归模型来评估出院后电话随访与HCAHPS的总体医院护理评分、住院医师沟通以及电子健康记录中的30天再入院率之间的关联。

结果

在4490名符合条件的患者中,1067名完成了电话随访(23.8%)。该干预与HCAHPS总体医院评分和HCAHPS医生沟通问题的回答在统计学上有显著改善相关(调整后的优势比为1.52,P = 0.04;调整后的优势比为1.56,P = 0.021),且因首次入院时的患者年龄而异(P = 0.001和P = 0.101)。随着住院时间延长,患者接受出院后电话随访后30天再入院率有所改善,但这一结果无统计学意义。

结论

本研究表明,负责出院的住院医师进行的出院后电话随访提高了患者满意度。需要进一步研究以了解该干预、30天医院再入院率和住院时间之间的因果关系。

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