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标准化出院流程对接受门诊肠外抗生素治疗患者30天再入院率的影响。

The Impact of a Standardized Discharge Process on 30-Day Readmissions for Patients on Outpatient Parenteral Antibiotic Treatment.

作者信息

Huggins Charnicia E, Park Tae Eun, Boateng Eric, Zeana Cosmina

机构信息

BronxCare Health System, Bronx, NY, USA.

Formerly of BronxCare Health System, Bronx, NY, USA.

出版信息

Hosp Pharm. 2022 Feb;57(1):107-111. doi: 10.1177/0018578720985434. Epub 2020 Dec 29.

DOI:10.1177/0018578720985434
PMID:35521026
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9065516/
Abstract

Outpatient parenteral antibiotic treatment (OPAT) is associated with shorter length of hospital stay and reduced cost. Yet, patients discharged home on OPAT are at risk of hospital readmissions due to adverse events and complications. Although the impact of a multidisciplinary approach to readmission has been assessed by previous studies, addition of an innovative technology has not been evaluated for OPAT. This study examines the impact of a multidisciplinary approach including automated voice calls on 30-day readmissions of OPAT patients. A post-discharge transitional care process (PDTCP) targeting OPAT patients was implemented in fall 2016. This process included an automated telephone patient engagement service and coordination among pharmacy, nursing, medicine, and social work personnel. The patients on OPAT received automated telephone calls at 2, 9, 16, 28, and 40 days post-discharge to ensure medication availability and adherence and to circumvent issues that would otherwise result in an emergency room visit or readmission to the hospital. A total 429 voice calls were made to 148 patients from November 8, 2016 to February 28, 2019. Overall, 61% (n = 90/148) of the patients were successfully reached by the automated voice system. The patients who were reached by the automated voice system were less likely to be readmitted than those not reached (18.9% vs 41.4%; relative risk (RR) 0.46, 95% CI 0.27-0.77,  = .003). Our study demonstrated that a multidisciplinary approach involving the use of automated telephone calls was associated with decreased hospital readmissions.

摘要

门诊胃肠外抗生素治疗(OPAT)与缩短住院时间和降低成本相关。然而,接受OPAT治疗后出院回家的患者因不良事件和并发症有再次入院的风险。尽管先前的研究已经评估了多学科方法对再入院的影响,但尚未对OPAT中添加创新技术进行评估。本研究探讨了包括自动语音呼叫在内的多学科方法对OPAT患者30天再入院的影响。2016年秋季实施了针对OPAT患者的出院后过渡护理流程(PDTCP)。该流程包括自动电话患者参与服务以及药房、护理、医学和社会工作人员之间的协调。接受OPAT治疗的患者在出院后第2、9、16、28和40天接到自动电话,以确保药物供应和依从性,并避免可能导致急诊就诊或再次住院的问题。从2016年11月8日至2019年2月28日,共对148名患者拨打了429次语音电话。总体而言,61%(n = 90/148)的患者通过自动语音系统成功接通。通过自动语音系统接通的患者比未接通的患者再次入院的可能性更小(18.9%对41.4%;相对风险(RR)0.46,95%可信区间0.27 - 0.77,P = 0.003)。我们的研究表明,采用包括自动电话呼叫在内的多学科方法与减少医院再入院相关。

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2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy.2018 年美国传染病学会门诊患者接受肠外抗菌治疗管理临床实践指南。
Clin Infect Dis. 2019 Jan 1;68(1):e1-e35. doi: 10.1093/cid/ciy745.
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