Hastings Susan N, Stechuchak Karen M, Coffman Cynthia J, Mahanna Elizabeth P, Weinberger Morris, Van Houtven Courtney H, Schmader Kenneth E, Hendrix Cristina C, Kessler Chad, Hughes Jaime M, Ramos Katherine, Wieland G Darryl, Weiner Madeline, Robinson Katina, Oddone Eugene
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, HSR&D, Fulton Street, Durham, NC, USA.
Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
J Gen Intern Med. 2020 Jan;35(1):79-86. doi: 10.1007/s11606-019-05319-6. Epub 2019 Sep 5.
Little research has been done on primary care-based models to improve health care use after an emergency department (ED) visit.
To examine the effectiveness of a primary care-based, nurse telephone support intervention for Veterans treated and released from the ED.
Randomized controlled trial with 1:1 assignment to telephone support intervention or usual care arms (ClinicalTrials.gov: NCT01717976).
Department of Veterans Affairs Health Care System (VAHCS) in Durham, NC.
Five hundred thirteen Veterans who were at high risk for repeat ED visits.
The telephone support intervention consisted of two core calls in the week following an ED visit. Call content focused on improving the ED to primary care transition, enhancing chronic disease management, and educating Veterans and family members about VHA and community services.
The primary outcome was repeat ED use within 30 days.
Observed rates of repeat ED use at 30 days in usual care and intervention groups were 23.1% and 24.9%, respectively (OR = 1.1; 95% CI = 0.7, 1.7; P = 0.6). The intervention group had a higher rate of having at least 1 primary care visit at 30 days (OR = 1.6, 95% CI = 1.1-2.3). At 180 days, the intervention group had a higher rate of usage of a weight management program (OR = 3.5, 95% CI = 1.6-7.5), diabetes/nutrition (OR = 1.8, 95% CI = 1.0-3.0), and home telehealth services (OR = 1.7, 95% CI = 1.0-2.9) compared with usual care.
A brief primary care-based nurse telephone support program after an ED visit did not reduce repeat ED visits within 30 days, despite intervention participants' increased engagement with primary care and some chronic disease management services.
ClinicalTrials.gov NCT01717976.
关于基于初级保健的模式以改善急诊科就诊后的医疗保健利用情况的研究较少。
研究基于初级保健的护士电话支持干预对在急诊科接受治疗并出院的退伍军人的有效性。
随机对照试验，按1:1分配至电话支持干预组或常规护理组（ClinicalTrials.gov：NCT01717976）。
北卡罗来纳州达勒姆的退伍军人事务部医疗保健系统（VAHCS）。
513名有再次前往急诊科高风险的退伍军人。
电话支持干预包括在急诊科就诊后的一周内进行两次核心电话随访。通话内容侧重于改善从急诊科到初级保健的过渡、加强慢性病管理以及向退伍军人及其家庭成员介绍退伍军人健康管理局（VHA）和社区服务。
主要结局是30天内再次前往急诊科就诊。
常规护理组和干预组30天内再次前往急诊科就诊的观察率分别为23.1%和24.9%（比值比[OR]=1.1；95%置信区间[CI]=0.7, 1.7；P=0.6）。干预组在30天内至少进行1次初级保健就诊的比例更高（OR=1.6，95%CI=1.1 - 2.3）。在180天时，与常规护理相比，干预组使用体重管理项目（OR=3.5，95%CI=1.6 - 7.5）、糖尿病/营养项目（OR=1.8，95%CI=1.0 - 3.0）和家庭远程医疗服务（OR=1.7，95%CI=1.0 - 2.9）的比例更高。
尽管干预参与者增加了对初级保健和一些慢性病管理服务的参与度，但急诊科就诊后基于初级保健的简短护士电话支持项目并未降低30天内再次前往急诊科就诊的次数。
ClinicalTrials.gov NCT01717976。
