Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
Center for Health care Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA.
Med Care. 2020 Apr;58(4):336-343. doi: 10.1097/MLR.0000000000001258.
Heart failure patients have high rates of repeat acute care use. Current efforts for risk prediction often ignore postdischarge data.
To identify postdischarge patient-reported clinical factors associated with repeat acute care use.
In a prospective cohort study that followed patients with chronic heart failure for 30 days postdischarge, for 7 days after discharge (or fewer days if patients used acute care within 7 days postdischarge), patients reported health status, heart failure symptoms, medication management, knowledge of follow-up plans, and other issues using a daily interactive automatic phone call.
A total of 156 patients who had responded to phone surveys.
The outcome variable was dichotomous 30-day acute care use (rehospitalization or emergency department visit). We examined the association between each patient-reported issue and the outcome, using multivariable logistic regression to adjust for confounders.
Patients were 63 years old (SD=12.4), with 51% African-American and 53% women. Within 30 days postdischarge, 30 (19%) patients used acute care. After adjustment, poor health status [odds ratio (OR)=3.53; 95% confidence interval (CI), 1.06-11.76], pain (OR=2.44; 95% CI, 1.02-5.84), and poor appetite (OR=3.05; 95% CI, 1.13-8.23) were positively associated with 30-day acute care utilization. Among 58 reports of pain in follow-up nursing notes, 39 (67%) were noncardiac, 2 (3%) were cardiac, and 17 (29%) were indeterminate.
Patient-reported poor health status, pain, and poor appetite were positively associated with 30-day acute care utilization. These novel postdischarge markers require further study before incorporation into risk prediction to drive quality improvement efforts.
心力衰竭患者再次接受急性护理的比例较高。目前的风险预测工作往往忽略了出院后的数据。
确定与再次接受急性护理使用相关的出院后患者报告的临床因素。
在一项前瞻性队列研究中，对慢性心力衰竭患者出院后 30 天内进行了随访，在出院后 7 天内（如果患者在出院后 7 天内使用了急性护理，则为更短的天数），患者使用每日互动自动电话报告健康状况、心力衰竭症状、药物管理、对随访计划的了解以及其他问题。
共 156 名对电话调查做出回应的患者。
因变量为 30 天内的急性护理使用（再住院或急诊就诊）的二分类变量。我们使用多变量逻辑回归来调整混杂因素，来检查每个患者报告的问题与结果之间的关联。
患者年龄为 63 岁（标准差=12.4），51%为非裔美国人，53%为女性。在出院后 30 天内，有 30 名（19%）患者使用了急性护理。调整后，健康状况差（比值比[OR]=3.53；95%置信区间[CI]，1.06-11.76）、疼痛（OR=2.44；95% CI，1.02-5.84）和食欲不振（OR=3.05；95% CI，1.13-8.23）与 30 天内急性护理利用呈正相关。在后续护理记录中报告的 58 次疼痛中，有 39 次（67%）为非心脏疼痛，2 次（3%）为心脏疼痛，17 次（29%）为不确定。
患者报告的健康状况差、疼痛和食欲不振与 30 天内急性护理的利用呈正相关。这些新的出院后标志物在纳入风险预测以推动质量改进工作之前需要进一步研究。
