Divison of General Internal Medicine and Geriatrics, OHSU, Portland, Oregon.
Institute for Aging Research in Boston, Harvard Medical School, Boston, Massachusetts.
J Am Geriatr Soc. 2020 Aug;68(8):1852-1856. doi: 10.1111/jgs.16523. Epub 2020 May 13.
Hospitalists are increasingly the attending physician for hospitalized patients, and the scheduling of their shifts can affect patient continuity. For dementia patients, the impact is unknown.
Longitudinal study using physician billing claims between 2000 and 2014 to examine the association of continuity of care with the insertion of a feeding tube (FT).
US hospitals.
Between 2000 and 2014, 166,056 hospitalizations of patients with a prior nursing home stay, advanced cognitive impairment, and impairments in four or more activities of daily living (mean age = 84.2 years; 30.4% male; 81.0% white).
Continuity of care measured at the hospital level with the Sequential Continuity Index (SECON; range = 0 to 100; higher score indicates higher continuity).
Rates of a hospitalist acting as the attending physician increased from 9.6% in 2000 to 22.6% in 2010, whereas a primary care physician with a predominant outpatient focus acting as the attending physician decreased from 50.3% in 2000 to 12.6% in 2014. Post-2010, a mixture of physician specialties increased from 55.5% to 66.4% with a reduction in hospitalists from 22.6% (2010) to 14.1% (2013). Continuity of care decreased over time with SECON dropping from 63.0 to 43.5. Adjusting for patient baseline risk factors, a nonlinear association was observed between SECON and FT insertion. Using cubic splines in the multivariate logistics regression model, the risk of FT insertion in hospitals where the SECON score dropped from 82 to 23 had an adjusted risk ratio (ARR) of FT insertion of 1.48 (95% confidence interval [CI] = 1.34-1.63); hospitals in which SECON dropped from 51 to 23 had an ARR of FT insertion of 1.38 (95% CI = 1.27-1.50).
Hospitalized dementia patients in hospitals in which continuity of care was lower had higher rates of FT insertions. Newer models of care are needed to enhance care continuity and thus ensure treatment consistent with likely outcomes of care and goals of care. J Am Geriatr Soc 68:1852-1856, 2020.
住院医师越来越成为住院患者的主治医生，他们的轮班时间安排可能会影响患者的连续性。对于痴呆症患者，其影响尚不清楚。
使用 2000 年至 2014 年期间的医师计费索赔进行的纵向研究，以检查护理连续性与插入饲管（FT）之间的关联。
美国医院。
2000 年至 2014 年期间，有 166056 名曾在疗养院居住、认知障碍严重、四项或更多日常生活活动受损的住院患者（平均年龄 84.2 岁；30.4%为男性；81.0%为白人）。
通过连续顺序指数（SECON）在医院层面上测量护理连续性（范围为 0 到 100；得分越高表示连续性越高）。
2000 年至 2010 年期间，担任主治医生的住院医师比例从 9.6%增加到 22.6%，而以门诊为主要重点的初级保健医生担任主治医生的比例从 50.3%减少到 2014 年的 12.6%。2010 年后，医生专业的混合比例从 55.5%增加到 66.4%，住院医师的比例从 22.6%（2010 年）减少到 14.1%（2013 年）。随着 SECON 从 63.0 降至 43.5，护理连续性随时间推移而下降。调整患者基线风险因素后，发现 SECON 与 FT 插入之间存在非线性关联。在多元逻辑回归模型中使用三次样条，SECON 评分从 82 降至 23 的医院中，FT 插入的校正风险比（ARR）为 1.48（95%置信区间[CI] = 1.34-1.63）；SECON 从 51 降至 23 的医院中，FT 插入的 ARR 为 1.38（95%CI = 1.27-1.50）。
护理连续性较低的住院痴呆症患者 FT 插入率更高。需要新的护理模式来增强护理连续性，从而确保治疗符合护理结果和护理目标的可能性。美国老年学会杂志 68：1852-1856，2020。
