老年患者出院至护理院接受临时护理后的老年随访是否能降低其再入院率：一项前后队列研究。
Does geriatric follow-up visits reduce hospital readmission among older patients discharged to temporary care at a skilled nursing facility: a before-and-after cohort study.
机构信息
Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
出版信息
BMJ Open. 2021 Aug 13;11(8):e046698. doi: 10.1136/bmjopen-2020-046698.
INTRODUCTION
Hospital readmission is a burden to patients, relatives and society. Older patients with frailty are at highest risk of readmission and its negative outcomes.
OBJECTIVE
We aimed at examining whether follow-up visits by an outgoing multidisciplinary geriatric team (OGT) reduces unplanned hospital readmission in patients discharged to a skilled nursing facility (SNF).
DESIGN
A retrospective single-centre before-and-after cohort study.
SETTING AND PARTICIPANTS
Study population included all hospitalised patients discharged from a Danish geriatric department to an SNF during 1 January 2016-25 February 2020. To address potential changes in discharge and readmission patterns during the study period, patients discharged from the same geriatric department to own home were also assessed.
INTERVENTION
OGT visits at SNF within 7 days following discharge. Patients discharged to SNF before 12 March 2018 did not receive OGT (-OGT). Patients discharged to SNF on or after 12 March 2018 received the intervention (+OGT).
MAIN OUTCOME MEASURES
Unplanned hospital readmission between 4 hours and 30 days following initial discharge.
RESULTS
Totally 847 patients were included (440 -OGT; 407 +OGT). No differences were seen between the two groups regarding age, sex, activities of daily living (ADLs), Charlson Comorbidity Index (CCI) or 30-day mortality. The cumulative incidence of readmission was 39.8% (95% CI 35.2% to 44.8%, n=162) in -OGT and 30.2% (95% CI 25.8% to 35.2%, n=113) in +OGT. The unadjusted risk (HR (95% CI)) of readmission was 0.68 (0.54 to 0.87, p=0.002) in +OGT compared with -OGT, and remained significantly lower (0.72 (0.57 to 0.93, p=0.011)) adjusting for age, length of stay, sex, ADL and CCI. For patients discharged to own home the risk of readmission remained unchanged during the study period.
CONCLUSION
Follow-up visits by OGT to patients discharged to temporary care at an SNF significantly reduced 30-day readmission in older patients.
介绍
医院再入院给患者、家属和社会带来负担。虚弱的老年患者再入院及其负面后果的风险最高。
目的
我们旨在研究出院后由多学科老年团队（OGT）进行随访是否可以降低出院至康复护理机构（SNF）的患者的非计划性再入院。
设计
回顾性单中心前后队列研究。
地点和参与者
研究人群包括 2016 年 1 月 1 日至 2020 年 2 月 25 日期间从丹麦老年科出院至 SNF 的所有住院患者。为了解决研究期间出院和再入院模式可能发生的变化，还评估了从同一老年科出院至自己家的患者。
干预措施
OGT 在出院后 7 天内在 SNF 进行随访。2018 年 3 月 12 日之前出院的患者未接受 OGT（-OGT）。2018 年 3 月 12 日或之后出院的患者接受了干预（+OGT）。
主要观察指标
初始出院后 4 小时至 30 天内的非计划性医院再入院。
结果
共纳入 847 例患者（-OGT 440 例；+OGT 407 例）。两组在年龄、性别、日常生活活动能力（ADL）、Charlson 合并症指数（CCI）或 30 天死亡率方面无差异。-OGT 组的再入院累积发生率为 39.8%（95%CI 35.2%至 44.8%，n=162），+OGT 组为 30.2%（95%CI 25.8%至 35.2%，n=113）。调整年龄、住院时间、性别、ADL 和 CCI 后，+OGT 组的再入院风险（95%CI 的 HR）为 0.68（0.54 至 0.87，p=0.002），调整后仍显著降低（0.72（0.57 至 0.93，p=0.011）。对于出院回家的患者，研究期间再入院风险保持不变。
结论
OGT 对出院至 SNF 临时护理的患者进行随访，可显著降低老年患者的 30 天再入院率。
Zotero 插件