患者因素与出院处置后老年患者再次急性医疗保健使用相关。
Patient Factors Linked with Return Acute Healthcare Use in Older Adults by Discharge Disposition.
机构信息
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Biostatistics, University of Virginia, Charlottesville, Virginia, USA.
出版信息
J Am Geriatr Soc. 2020 Oct;68(10):2279-2287. doi: 10.1111/jgs.16645. Epub 2020 Jul 16.
OBJECTIVES
Compare patient characteristics by hospital discharge disposition (home without services, home with home healthcare (HHC) services, or post-acute care (PAC) facilities). Examine timing and rates of 30-day healthcare utilization (rehospitalization, emergency department (ED) visit, or observation (OBS) visit) and patient characteristics associated with rehospitalization by discharge location.
DESIGN
Retrospective analysis of hospital administrative and clinical data.
SETTING AND PARTICIPANTS
A total of 3,294 older adult inpatients discharged home with or without HHC services or to a PAC facility.
MEASUREMENTS
Patient-level sociodemographic and clinical characteristics. Number of and time to occurrences of rehospitalization or ED/OBS visit within 30 days of hospital discharge.
RESULTS
Most rehospitalizations and ED/OBS visits occurred within 14 days from hospital discharge. Patients who returned within 24 hours came mostly from inpatient rehabilitation facilities (IRFs). More intense levels of PAC services were linked with higher rehospitalization risk. However, specific predictors differed by discharge location. Being unemployed, being single, and having more comorbidities were most associated with rehospitalization in those who went home with or without services, whereas patients rehospitalized from IRFs were younger, with less chronic illness burden, but greater and recent functional decline. Those discharged with HHC services had more return ED/OBS visits.
CONCLUSIONS
Although sicker patients were referred for more intense levels of PAC services, patients with greater chronic illness burden were still most often rehospitalized. In addition to unique patient differences, rehospitalizations from IRF within 24 hours suggest systems factors are contributory. Most return acute healthcare utilization occurred within 14 days; therefore, interventions should focus on smoothing transitions to all discharge locations. Because predictors of rehospitalization risk differed by discharge disposition, future research is necessary to study approaches aimed at matching patients' care needs with the most suitable PAC services at the right time. J Am Geriatr Soc 68:2279-2287, 2020.
目的
比较出院安置（无服务居家、居家医疗保健服务（HHC）居家和急性后期护理（PAC）机构）患者的特征。考察 30 天内医疗保健利用（再入院、急诊部（ED）就诊或观察（OBS）就诊）的时间和比率，以及与出院地点相关的再入院患者特征。
设计
医院行政和临床数据的回顾性分析。
地点和参与者
总共 3294 名老年住院患者出院时居家接受 HHC 服务或不接受服务，或入住 PAC 机构。
测量
患者水平的社会人口统计学和临床特征。出院后 30 天内再入院或 ED/OBS 就诊的次数和时间。
结果
大多数再入院和 ED/OBS 就诊发生在出院后 14 天内。24 小时内返回的患者主要来自住院康复设施（IRF）。更密集的 PAC 服务水平与更高的再入院风险相关。然而，具体的预测因素因出院地点而异。失业、单身和合并症更多的患者与居家接受或不接受服务的患者再入院最相关，而从 IRF 再入院的患者更年轻，慢性疾病负担更小，但功能下降更大且更近期。接受 HHC 服务的患者返回急诊部/OBS 的就诊次数更多。
结论
尽管病情较重的患者被推荐接受更密集的 PAC 服务，但慢性病负担较重的患者仍然最常再入院。除了患者个体差异外，24 小时内从 IRF 再入院表明系统因素是促成因素。大多数急性医疗保健的再利用发生在 14 天内；因此，干预措施应侧重于顺利过渡到所有出院地点。由于再入院风险的预测因素因出院处置而异，因此需要进一步研究旨在将患者的护理需求与最合适的 PAC 服务在正确的时间相匹配的方法。美国老年学会杂志 68：2279-2287，2020 年。
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