Koch Daniel, Kutz Alexander, Haubitz Sebastian, Baechli Ciril, Gregoriano Claudia, Conca Antoinette, Volken Thomas, Schuetz Philipp, Mueller Beat
Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Appl Nurs Res. 2020 Aug;54:151274. doi: 10.1016/j.apnr.2020.151274. Epub 2020 May 4.
There is growing evidence that patients with functional decline are at increased risk of readmission, mortality and institutionalization. Instruments to measure the status of self-care could provide important information for efficient care planning. The widely used Self Care Index serves as an indicator for the severity of nursing dependency. To date, no evidence is available on the association of the instrument with rehospitalization, mortality and institutionalization.
To examine the association of functional status measures (Self Care Index on admission, at discharge and functional decline) with 30-day mortality, readmission and institutionalization in hospitalized non-surgical patients.
Prospective cohort study.
We included 4540 emergency medical patients at a single hospital in Switzerland.
Primary outcome was 30-day mortality rate; secondary outcomes were 30-day readmission and institutionalization. We analyzed the association of the functional status with the binary endpoints using logistic regression models and C-statistics for discrimination.
All of the examined measures were significant predictors of overall 30-day mortality; Self Care Index on admission: adj. OR: 0.90 (95% CI: 0.87-0.92); Self Care Index at discharge: adj. OR: 0.86 (95% CI: 0.83-0.88); functional decline: adj. OR: 1.22 (95% CI: 1.14-1.31) and all Self Care Index single items. A combined model (functional status on admission and functional decline during hospitalization) showed a good accuracy with regard to the AUC: adj. AUC: 0.80 (95% CI: 0.74-0.86).
Several functional measures were associated with 30-day mortality. Self Care Index total score, five single items and a combined model showed the best performance.
越来越多的证据表明，功能衰退的患者再次入院、死亡和入住养老院的风险增加。测量自我护理状况的工具可为有效的护理计划提供重要信息。广泛使用的自我护理指数可作为护理依赖严重程度的指标。迄今为止，尚无证据表明该工具与再次住院、死亡和入住养老院之间存在关联。
探讨功能状态指标（入院时、出院时的自我护理指数及功能衰退情况）与非手术住院患者30天死亡率、再次入院率和入住养老院情况之间的关联。
前瞻性队列研究。
我们纳入了瑞士一家医院的4540例急诊患者。
主要结局为30天死亡率；次要结局为30天再次入院率和入住养老院情况。我们使用逻辑回归模型和用于区分的C统计量分析功能状态与二元结局之间的关联。
所有检测指标均为30天总体死亡率的显著预测因素；入院时自我护理指数：调整后比值比：0.90（95%置信区间：0.87 - 0.92）；出院时自我护理指数：调整后比值比：0.86（95%置信区间：0.83 - 0.88）；功能衰退：调整后比值比：1.22（95%置信区间：1.14 - 1.31）以及所有自我护理指数单项指标。一个综合模型（入院时的功能状态和住院期间的功能衰退情况）在AUC方面显示出良好的准确性：调整后AUC：0.80（95%置信区间：0.74 - 0.86）。
多项功能指标与30天死亡率相关。自我护理指数总分、五个单项指标以及一个综合模型表现最佳。
