在药师主导的过渡期医疗护理计划中，LACE 指数能否帮助识别出无保险且有随访脱落风险的患者？
Can the LACE index help identify uninsured patients at risk of loss to follow-up during a pharmacist-led transitions of care program?
出版信息
J Am Pharm Assoc (2003). 2022 Mar-Apr;62(2):564-568. doi: 10.1016/j.japh.2021.11.001. Epub 2021 Nov 3.
BACKGROUND
Uninsured patients are susceptible to being lost to follow-up (LTFU). In addition to being uninsured, follow-up is especially critical among this population during transitions of care when patients are discharged from the hospital setting back to home because follow-up care after discharge has been proven to prevent readmissions. The LACE tool has historically been used to predict readmissions, but the LACE tool has not been used to evaluate patients' risk of LTFU.
OBJECTIVE
To understand the potential translation of the LACE tool for use in uninsured patients' follow-up care, we assessed the association between LACE index scores and patients' risk of LTFU during a pharmacist-led transitions of care program for uninsured patients.
METHODS
Data were extracted from a randomized controlled trial implementing a pharmacist-led transitions of care program at an indigent care clinic. The study population included uninsured adult patients (>18 years old) who spoke English and attended a clinical visit with a pharmacist within 16 days after discharge from a community hospital. Analyses sought to determine factors associated with the patients' LTFU status.
RESULTS
Among 88 enrolled participants, 29 participants (32.95%) were LTFU. Thirty-two patients (36.4%) had a high LACE index score at baseline, indicating an increased risk of 30-day readmission. Of the remaining 56 patients (63.6%) with low-to-moderate LACE index scores, 54 (61.4%) had a moderate LACE index score, and only 2 (2.3%) had a low LACE index score. Uninsured patients with high LACE index scores had 70% lower odds of being LTFU than uninsured patients with low-to-moderate LACE index scores (exact odds ratio 0.297 [95% CI 0.081-0.947]).
CONCLUSION
The LACE index score was inversely related to the risk of LTFU during a pharmacist-led transitions of care program. Pharmacists may use the LACE tool to identify patients at high risk of LTFU.
背景
未参保患者容易失去随访（LTFU）。除了未参保外，在患者从医院环境出院回到家中的医疗过渡期，随访尤其重要，因为已证实出院后的随访护理可以预防再次入院。LACE 工具历来用于预测再次入院，但尚未用于评估患者 LTFU 的风险。
目的
为了了解 LACE 工具在未参保患者随访护理中的潜在应用，我们评估了 LACE 指数评分与药师主导的未参保患者医疗过渡期项目中患者 LTFU 风险之间的关联。
方法
数据来自一项在贫困患者诊所实施药师主导的医疗过渡期项目的随机对照试验中提取。研究人群包括英语患者（>18 岁），他们在社区医院出院后 16 天内就诊药师。分析旨在确定与患者 LTFU 状态相关的因素。
结果
在 88 名入组参与者中，有 29 名（32.95%）患者 LTFU。32 名患者（36.4%）基线时 LACE 指数评分较高，表明 30 天内再次入院的风险增加。在其余 56 名（63.6%）低中度 LACE 指数评分的患者中，54 名（61.4%）为中度 LACE 指数评分，仅有 2 名（2.3%）为低度 LACE 指数评分。LACE 指数评分较高的未参保患者与低中度 LACE 指数评分的未参保患者相比，LTFU 的可能性降低 70%（确切比值比 0.297 [95%CI 0.081-0.947]）。
结论
在药师主导的医疗过渡期项目中，LACE 指数评分与 LTFU 风险呈负相关。药师可以使用 LACE 工具来识别 LTFU 风险高的患者。
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