Indiana University School of Medicine, Indianapolis, IN, USA.
Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush VA Medical Center, Indianapolis, IN, USA.
J Am Med Dir Assoc. 2022 Jan;23(1):105-110. doi: 10.1016/j.jamda.2021.05.042. Epub 2021 Jun 25.
Potentially avoidable hospitalizations are harmful to nursing home residents. Despite extensive care transitions research, no studies have described transfers originating outside the nursing home (eg, visiting family members or at a dialysis center). This article describes 82 out-of-facility (community) transfers and compares them to transfers originating within the nursing home (direct transfers).
Secondary data analysis with multivariable model for community transfer risk factors.
Eighty-two community transfers and 1362 transfers originating in the nursing home, involving 870 residents enrolled in the OPTIMISTIC demonstration project between January 1, 2015, and June 30, 2016.
Transfers were compared using data from the Minimum Data Set and root cause analyses performed at time of transfer. Multivariable associations were assessed at the transfer level to define risk factors for community transfers. Project nurses collected data on community transfers to inform a root cause analysis.
Residents with community transfers were younger (74.4 years vs 78.2 years), with lower prevalence of cognitive impairment (44.8% vs 70.3%) and higher rates of heart failure (38.7% vs 23.3%) than residents with direct transfers. Community transfers were more likely due to cardiovascular illness (31.2% vs 8.7%), whereas less likely to be for cognitive, behavioral, and psychiatric concerns (11.7% vs 22.7%). Nearly half (46%) of community transfers originated at dialysis centers. Residents transferred outside the nursing home were less likely to have documented limitations to care such as a do not resuscitate code status. Communication during community transfers was identified on root cause analyses as a potential area for improvement.
Community transfers were more likely to occur in younger residents with higher rates of cardiovascular disease and lower rates of cognitive impairment. Improved communication between nursing home staff and outside providers as well as more extensive advance care planning for residents with cardiovascular disease may reduce community transfers.
可避免的住院对养老院居民是有害的。尽管有广泛的护理过渡研究，但没有研究描述过起源于养老院之外的转移（例如，探访的家庭成员或在透析中心）。本文描述了 82 例院外（社区）转移，并将其与起源于养老院的转移（直接转移）进行了比较。
二次数据分析，采用多变量模型分析社区转移的风险因素。
82 例社区转移和 1362 例起源于养老院的转移，涉及 2015 年 1 月 1 日至 2016 年 6 月 30 日参与 OPTIMISTIC 示范项目的 870 名居民。
通过最低数据集和转移时进行的根本原因分析比较转移。在转移水平上评估多变量关联，以确定社区转移的风险因素。项目护士收集社区转移数据以进行根本原因分析。
与直接转移的居民相比，社区转移的居民年龄更小（74.4 岁 vs 78.2 岁），认知障碍的发生率更低（44.8% vs 70.3%），心力衰竭的发生率更高（38.7% vs 23.3%）。社区转移更可能是由于心血管疾病（31.2% vs 8.7%），而不太可能是由于认知、行为和精神问题（11.7% vs 22.7%）。近一半（46%）的社区转移起源于透析中心。院外转移的居民不太可能有记录在案的护理限制，如不复苏代码状态。在根本原因分析中，社区转移过程中的沟通被确定为一个潜在的改进领域。
社区转移更可能发生在年龄较小、心血管疾病发生率较高、认知障碍发生率较低的居民中。改善养老院工作人员与外部提供者之间的沟通，并为患有心血管疾病的居民制定更广泛的预先护理计划，可能会减少社区转移。
