El Hachem Pierre, Pasniciuc Silviu, Khurana Saurabh, Samala Renato V, Rybicki Lisa A, Lagman Ruth L, Davis Mellar P
Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA.
Department of Quantitative Health Sciences, 2569Cleveland Clinic, Cleveland, OH, USA.
J Palliat Care. 2023 Apr;38(2):200-206. doi: 10.1177/08258597221119325. Epub 2022 Aug 5.
OBJECTIVE(S): For patients with cancer, the emergence of acute palliative care units (APCU) may hold promise in curtailing hospital readmissions. The study aims to describe the characteristics of patients readmitted to an APCU.
This retrospective study examined patients with cancer readmitted within 30 days to an APCU. Readmissions were further classified as either potentially preventable or non-preventable.
Out of 734 discharges from July 1, 2014 to July 1, 2015, 69 (9%) readmissions were identified and analyzed. For index admissions, median length of stay was five days, and one (1%) was discharged home with hospice care. For readmissions, median time from index admission to readmission was nine days, median length of stay was six days, three (4%) patients died, and 20 (30%) went home with hospice. Ten (14.5%) readmissions were deemed potentially preventable (95% CI 7.2-25.0%). Race/ethnicity-White/Black/Hispanic/Others-was 60%, 10%, 20% and 10%, respectively, among potentially preventable readmissions and 76%, 22%, 2% and 0%, respectively, among potentially non-preventable readmissions (P = .012). Potentially preventable readmissions were more likely to have venous thromboembolism (40% vs. 12%, P = .046) and more reasons for readmission (median 2 vs. 1, P = .019).
Among patients with cancer readmitted to an APCU, one out of seven was potentially preventable and a far larger proportion was discharged with hospice care compared to the index admission. Recognition of disease course, meaningful goals of care discussions and timely transition to hospice care may reduce rehospitalization in this population.
对于癌症患者而言，急性姑息治疗病房（APCU）的出现或许有望减少医院再入院情况。本研究旨在描述再次入住APCU的患者特征。
这项回顾性研究对在30天内再次入住APCU的癌症患者进行了检查。再入院情况进一步分为潜在可预防和不可预防两类。
在2014年7月1日至2015年7月1日的734例出院病例中，确定并分析了69例（9%）再入院病例。首次入院时，中位住院时间为5天，1例（1%）患者在临终关怀护理下出院回家。对于再入院病例，从首次入院到再入院的中位时间为9天，中位住院时间为6天，3例（4%）患者死亡，20例（30%）患者在临终关怀护理下回家。10例（14.5%）再入院病例被认为是潜在可预防的（95%置信区间7.2 - 25.0%）。在潜在可预防的再入院病例中，种族/族裔——白人/黑人/西班牙裔/其他——分别为60%、10%、20%和10%，而在潜在不可预防的再入院病例中分别为76%、22%、2%和0%（P = 0.012）。潜在可预防的再入院病例更有可能发生静脉血栓栓塞（40%对12%，P = 0.046），且再入院原因更多（中位值2对1，P = 0.019）。
在再次入住APCU的癌症患者中，七分之一的病例是潜在可预防的，与首次入院相比，有更大比例的患者在临终关怀护理下出院。认识疾病进程、进行有意义的护理目标讨论以及及时过渡到临终关怀护理可能会减少该人群的再次住院情况。
