家庭综合姑息治疗纳入时间对急诊科就诊的影响。
Impact of the Timing of Integrated Home Palliative Care Enrolment on Emergency Department Visits.
机构信息
Department of Public Health and Paediatrics, University of Turin, Torino, Italy.
Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy.
出版信息
Int J Health Policy Manag. 2022 Dec 19;11(12):2964-2971. doi: 10.34172/ijhpm.2022.5783. Epub 2022 May 17.
BACKGROUND
The association between timing of integrated home palliative care (IHPC) enrolment and emergency department (ED) visits is still under debate, and no studies investigated the effect of the timing of IHPC enrolment on ED visits, according to their level of emergency. This study aimed to investigate the impact of the timing of IHPC enrolment on different acuity ED visits.
METHODS
A retrospective, pre-/post-intervention study was conducted from 2013 to 2019 in Italy. Analyses were stratified by IHPC duration (short ≤30 days; medium 31-90 days; long >90 days) and triage tags (white/green: low level of emergency visit; yellow/red: medium-to-high level). The impact of the timing of IHPC enrolment was evaluated in two ways: incidence rate ratios (IRRs) of ED visits were determined (1) before and after IHPC enrolment in each group and (2) post-IHPC among groups.
RESULTS
A cohort of 17 983 patients was analysed. Patients enrolled early in the IHPC programme had a significantly lower incidence rate of ED visits than the pre-enrolment period (IRR=0.65). The incidence rates of white/green and yellow/red ED visits were significantly lower post-IHPC enrolment for patients enrolled early (IRR=0.63 and 0.67, respectively). All results were statistically significant (<.001). Comparing the IHPC groups after enrolment versus the short group, medium and long IHPC groups had a significant reduction of ED visits (IRR=0.37, IRR=0.14 respectively), showing a relation between the timing of IHPC enrolment and the incidence of ED visits. A similar trend was observed after accounting for triage tags of ED visits.
CONCLUSION
The timing of IHPC enrolment is related with a variation of the incidence of ED visits. Early IHPC enrolment is related to a high significant reduction of ED visits when compared to the 90-day pre-IHPC enrolment period and to late IHPC enrolment, accounting for both low-level and medium-to-high level emergency ED visits.
背景
综合家庭姑息治疗（IHPC）登记时间与急诊科（ED）就诊之间的关系仍存在争议，尚无研究调查 IHPC 登记时间对 ED 就诊的影响，以及根据其紧急程度的不同。本研究旨在调查 IHPC 登记时间对不同严重程度 ED 就诊的影响。
方法
这是一项在意大利进行的回顾性、前后干预研究，时间跨度为 2013 年至 2019 年。分析按 IHPC 持续时间（短 ≤30 天；中 31-90 天；长＞90 天）和分诊标签（白/绿：低紧急就诊水平；黄/红：中-高紧急就诊水平）进行分层。通过两种方式评估 IHPC 登记时间的影响：（1）在每个组中登记 IHPC 前后确定 ED 就诊的发病率比值（IRR），（2）登记 IHPC 后比较各组的 IRR。
结果
分析了 17983 例患者的队列。与登记 IHPC 前相比，早期登记 IHPC 的患者 ED 就诊的发生率显著降低（IRR=0.65）。早期登记 IHPC 的患者的白/绿和黄/红 ED 就诊的发生率在登记 IHPC 后显著降低（IRR=0.63 和 0.67）。所有结果均具有统计学意义（<.001）。与短组相比，登记 IHPC 后比较中、长 IHPC 组 ED 就诊次数明显减少（IRR=0.37，IRR=0.14），提示 IHPC 登记时间与 ED 就诊次数之间存在关系。在考虑 ED 就诊的分诊标签后，也观察到类似的趋势。
结论
IHPC 登记时间与 ED 就诊次数的变化有关。与登记 IHPC 前 90 天相比，早期 IHPC 登记与 ED 就诊次数的显著减少相关，并且与晚期 IHPC 登记相比，低紧急和中-高紧急 ED 就诊的次数均减少。
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