Keng Christine J S, Goriawala Alifiya, Rashid Saira, Goldstein Rachel, Schmocker Selina, Easson Alexandra, Kennedy Erin
Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
J Patient Exp. 2020 Dec;7(6):1241-1246. doi: 10.1177/2374373520904194. Epub 2020 Feb 12.
Patients undergoing colorectal surgery are vulnerable during their transition from hospital to home and require increased support following discharge from hospital. Study objectives were to perform an initial assessment of patient uptake, outcomes, and satisfaction with an integrated discharge monitoring system called Home to Stay.
The intervention was an integrated discharge monitoring system that uses a mobile app platform. Patients downloaded the app prior to discharge from hospital and received a Daily Health Check day #1 to #14, #21, and #30. Patient responses' were accessed by the health-care team via secure web site, and extreme responses were "flagged" to indicate that a follow-up telephone call was necessary. Primary outcomes were patient uptake, Quality of Recovery scores and satisfaction with the program. Secondary outcomes were 30-day emergency room (ER) visits and readmissions.
One hundred and thirty-two patients were invited to participate and 106 accepted. Of these, 93 used the app at least once. The mean overall score on the Quality of Recovery Scale increased significantly from day 1 to day 14. Patient satisfaction with the app was high, with 92% of patients reporting overall satisfaction as good or excellent. The 30-day readmission rate was 6% and was lower than the 30-day readmission rate of 18% reported for the 4 months prior to the start of the study.
The Home to Stay Program to support patients at home after colorectal surgery is feasible with high patient uptake and satisfaction. This program has the potential to reduce 30-day readmissions, however further studies are required.
接受结直肠手术的患者在从医院过渡到家庭的过程中较为脆弱，出院后需要更多支持。研究目的是对一种名为“居家安心”的综合出院监测系统的患者接受情况、结果和满意度进行初步评估。
干预措施是一个使用移动应用程序平台的综合出院监测系统。患者在出院前下载该应用程序，并在第1天至第14天、第21天和第30天接受每日健康检查。医疗团队通过安全网站访问患者的回复，极端回复会被“标记”，表明需要进行后续电话随访。主要结果是患者接受情况、恢复质量评分和对该项目的满意度。次要结果是30天内急诊室就诊和再入院情况。
邀请了132名患者参与，106名患者接受邀请。其中，93名患者至少使用过一次该应用程序。恢复质量量表的平均总分从第1天到第14天显著提高。患者对该应用程序的满意度较高，92%的患者报告总体满意度为良好或优秀。30天再入院率为6%，低于研究开始前4个月报告的18%的30天再入院率。
“居家安心”项目在结直肠手术后为患者提供居家支持是可行的，患者接受度和满意度较高。该项目有可能降低30天再入院率，然而还需要进一步研究。
