Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System.
Department of Surgery, Stanford-Surgery Policy, Improvement Research, and Education (S-SPIRE) Center, Stanford University School of Medicine, Palo Alto, CA.
Med Care. 2021 Oct 1;59(10):864-871. doi: 10.1097/MLR.0000000000001600.
Quality of life and psychosocial determinants of health, such as health literacy and social support, are associated with increased health care utilization and adverse outcomes in medical populations. However, the effect on surgical health care utilization is less understood.
We sought to examine the effect of patient-reported quality of life and psychosocial determinants of health on unplanned hospital readmissions in a surgical population.
This is a prospective cohort study using patient interviews at the time of hospital discharge from a Veterans Affairs hospital.
We include Veterans undergoing elective inpatient general, vascular, or thoracic surgery (August 1, 2015-June 30, 2017).
We assessed unplanned readmission to any medical facility within 30 days of hospital discharge.
A total of 736 patients completed the 30-day postoperative follow-up, and 16.3% experienced readmission. Lower patient-reported physical and mental health, inadequate health literacy, and discharge home with help after surgery or to a skilled nursing or rehabilitation facility were associated with an increased incidence of readmission. Classification regression identified the patient-reported Veterans Short Form 12 (SF12) Mental Component Score <31 as the most important psychosocial determinant of readmission after surgery.
Mental health concerns, inadequate health literacy, and lower social support after hospital discharge are significant predictors of increased unplanned readmissions after major general, vascular, or thoracic surgery. These elements should be incorporated into routinely collected electronic health record data. Also, discharge plans should accommodate varying levels of health literacy and consider how the patient's mental health and social support needs will affect recovery.
生活质量和健康的社会心理决定因素，如健康素养和社会支持，与医疗人群中医疗利用率的增加和不良结局有关。然而，其对手术医疗保健利用率的影响尚不清楚。
我们旨在研究患者报告的生活质量和健康的社会心理决定因素对手术人群中计划外住院再入院的影响。
这是一项使用退伍军人事务医院出院时患者访谈的前瞻性队列研究。
我们纳入了接受择期住院普通、血管或胸外科手术的退伍军人（2015 年 8 月 1 日至 2017 年 6 月 30 日）。
我们评估了出院后 30 天内任何医疗设施的计划外再入院情况。
共有 736 名患者完成了 30 天的术后随访，16.3%的患者发生了再入院。患者报告的身体和心理健康状况较差、健康素养不足，以及出院时在家中接受帮助或入住熟练护理或康复设施，与再入院发生率增加相关。分类回归确定患者报告的退伍军人简短表格 12 （SF12）精神成分评分<31 是手术后再入院的最重要的社会心理决定因素。
出院后心理健康问题、健康素养不足和社会支持度较低是普通、血管或胸外科手术后计划外再入院增加的重要预测因素。这些因素应纳入常规电子健康记录数据中。此外，出院计划应适应不同水平的健康素养，并考虑患者的心理健康和社会支持需求将如何影响康复。
