Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan.
School of Nursing, China Medical University, Taichung City, Taiwan.
Aging Clin Exp Res. 2022 Aug;34(8):1939-1946. doi: 10.1007/s40520-022-02109-9. Epub 2022 Apr 20.
Home healthcare (HHC) provides continuous care for disabled patients. However, HHC referral after the emergency department (ED) discharge remains unclear. Thus, this study aimed its clarification.
A computer-assisted HHC referral by interdisciplinary collaboration among emergency physicians, case managers, nurse practitioners, geriatricians, and HHC nurses was built in a tertiary medical center in Taiwan. Patients who had HHC referrals after ED discharge between February 1, 2020 and September 31, 2020, were recruited into the study. A non-ED HHC cohort who had HHC referrals after hospitalization from the ED was also identified. Comparison for clinical characteristics and uses of medical resources was performed between ED HHC and non-ED HHC cohorts.
The model was successfully implemented. In total, 34 patients with ED HHC and 40 patients with non-ED HHC were recruited into the study. The female proportion was 61.8% and 67.5%, and the mean age was 81.5 and 83.7 years in ED HHC and non-ED HHC cohorts, respectively. No significant difference was found in sex, age, underlying comorbidities, and ED diagnoses between the two cohorts. The ED HHC cohort had a lower median total medical expenditure within 3 months (34,030.0 vs. 56,624.0 New Taiwan Dollars, p = 0.021) compared with the non-ED HHC cohort. Compared to the non-ED HHC cohort, the ED HHC cohort had a lower ≤ 1 month ED visit, ≤ 6 months ED visit, and ≤ 3 months hospitalization; however, differences were not significant.
An innovative ED HHC model was successfully implemented. Further studies with more patients are warranted to investigate the impact.
家庭医疗保健（HHC）为残疾患者提供持续护理。然而，HHC 在急诊科（ED）出院后的转介情况仍不清楚。因此，本研究旨在阐明这一点。
在台湾的一家三级医疗中心，通过急诊医师、个案经理、执业护士、老年病学家和 HHC 护士之间的跨学科合作，建立了计算机辅助的 HHC 转介。招募了 2020 年 2 月 1 日至 2020 年 9 月 31 日期间在 ED 出院后接受 HHC 转介的患者。还确定了从 ED 住院后接受 HHC 转介的非 ED HHC 队列。对 ED HHC 和非 ED HHC 队列的临床特征和医疗资源使用情况进行了比较。
该模型成功实施。共有 34 名 ED HHC 患者和 40 名非 ED HHC 患者入组。女性比例分别为 61.8%和 67.5%，ED HHC 和非 ED HHC 队列的平均年龄分别为 81.5 岁和 83.7 岁。两组在性别、年龄、基础合并症和 ED 诊断方面无显著差异。ED HHC 队列在 3 个月内的总医疗支出中位数较低（34030.0 新台币与 56624.0 新台币，p=0.021）与非 ED HHC 队列相比。与非 ED HHC 队列相比，ED HHC 队列的 ED 就诊次数≤1 个月、ED 就诊次数≤6 个月和住院次数≤3 个月均较低；然而，差异无统计学意义。
成功实施了一种创新的 ED HHC 模式。需要进一步研究更多患者，以调查其影响。
