居家护理中的护理连续性：对老年痴呆症患者再住院的影响。
Continuity of Nursing Care in Home Health: Impact on Rehospitalization Among Older Adults With Dementia.
机构信息
New York University Rory Meyers College of Nursing.
Center for Home Care Policy and Research at the Visiting Nurse Service of New York, New York.
出版信息
Med Care. 2021 Oct 1;59(10):913-920. doi: 10.1097/MLR.0000000000001599.
BACKGROUND
Home health care (HHC) is a leading form of home and community-based services for persons with dementia (PWD). Nurses are the primary providers of HHC; however, little is known of nursing care delivery and quality.
OBJECTIVE
The objective of this study was to examine the association between continuity of nursing care in HHC and rehospitalization among PWD.
RESEARCH DESIGN
This is a retrospective cohort study using multiple years (2010-2015) of HHC assessment, administrative, and human resources data from a large urban not-for-profit home health agency.
SUBJECTS
This study included 23,886 PWD receiving HHC following a hospitalization.
MEASURES
Continuity of nursing care was calculated using the Bice and Boxerman method, which considered the number of total visits, nurses, and visits from each nurse during an HHC episode. The outcome was all-cause rehospitalization during HHC. Risk-adjusted logistic regression was used for analysis.
RESULTS
Approximately 24% of PWD were rehospitalized. The mean continuity of nursing care score was 0.56 (SD=0.33). Eight percent of PWD received each nursing visit from a different nurse (no continuity), and 26% received all visits from one nurse during an HHC episode (full continuity). Compared with those receiving high continuity of nursing care (third tertile), PWD receiving low (first tertile) or moderate (second tertile) continuity of nursing care had an adjusted odds ratio of 1.33 (95% confidence interval: 1.25-1.46) and 1.30 (95% confidence interval: 1.22-1.43), respectively, for being rehospitalized.
CONCLUSIONS
Wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations.
背景
家庭保健（HHC）是为痴呆症患者（PWD）提供家庭和社区服务的主要形式。护士是 HHC 的主要提供者；然而，对于护理服务的提供和质量知之甚少。
目的
本研究旨在探讨 HHC 中护理连续性与 PWD 再住院之间的关系。
研究设计
这是一项使用多年（2010-2015 年）HHC 评估、行政和人力资源数据的回顾性队列研究，来自一家大型城市非营利性家庭保健机构。
研究对象
这项研究包括 23886 名在住院治疗后接受 HHC 的 PWD。
测量
使用 Bice 和 Boxerman 方法计算护理连续性，该方法考虑了 HHC 期间的总访问次数、护士人数和每位护士的访问次数。结果是 HHC 期间的全因再住院。采用风险调整的逻辑回归进行分析。
结果
约 24%的 PWD 再次住院。护理连续性的平均得分是 0.56（标准差=0.33）。8%的 PWD 每次接受护理访问都来自不同的护士（无连续性），而 26%的 PWD 在 HHC 期间的所有访问都来自一名护士（完全连续性）。与接受高护理连续性（第三 tertile）的患者相比，接受低（第一 tertile）或中等（第二 tertile）护理连续性的患者的调整后比值比分别为 1.33（95%置信区间：1.25-1.46）和 1.30（95%置信区间：1.22-1.43），再次住院的风险增加。
结论
PWD 的护理连续性存在广泛差异。在为 PWD 提供 HHC 访问时，护士人员的一致性对于预防再住院至关重要。
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