基于电子健康记录的移动性评估和自动转介进行住院物理治疗对患者结局的影响：一项准实验研究。
Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study.
机构信息
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
出版信息
Health Serv Res. 2023 Feb;58 Suppl 1(Suppl 1):51-62. doi: 10.1111/1475-6773.14087. Epub 2022 Nov 20.
OBJECTIVE
To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission.
DATA SOURCES
EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017-February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019-July 2021).
STUDY DESIGN
We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted.
DATA EXTRACTION
We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay.
PRINCIPAL FINDINGS
In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI -0.57, -0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β = 0.01; 95% CI -0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI -0.88, -0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA.
CONCLUSIONS
Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.
目的
评估由嵌入电子健康记录（EHR）并由护理人员在入院时完成的移动性评估得分触发的医院物理治疗（PT）转诊的效果。
数据来源
宾夕法尼亚州西部一个医疗系统的 12 家急性护理医院（2017 年 1 月至 2018 年 2 月）和俄亥俄州东北部一个医疗系统的 11 家急性护理医院的 EHR 和计费数据（2019 年 8 月至 2021 年 7 月）。
研究设计
我们利用回归不连续性设计比较了达到 EHR-PT 转诊（治疗）移动性评分阈值的宾夕法尼亚州医院收治的中风患者与未达到该阈值的患者（对照组）。结果是住院时间（LOS）和 30 天再入院或死亡率。控制变量包括人口统计学、保险、收入和合并症。还比较了有 EHR-PT 转诊的医院系统与没有转诊的医院系统（俄亥俄州的医院作为替代对照组）。还根据年龄进行了亚组分析。
数据提取
我们确定了患有原发性或继发性中风且由护理人员完成移动性评估的成年患者（宾夕法尼亚州的医院有 4859 例，俄亥俄州的医院有 1749 例），这些患者完成了住院治疗。
主要发现
在宾夕法尼亚州的医院，与对照组相比，接受 EHR-PT 转诊的患者 30 天再入院或死亡率降低了 11.4 个百分点（95%CI-0.57，-0.01）。在俄亥俄州的医院，30 天再入院的情况并未观察到这种效果（β=0.01；95%CI-0.25，0.26）。在宾夕法尼亚州，60 岁以上接受 EHR-PT 转诊的成年人再入院或死亡的风险降低了 26.2 个百分点（95%CI-0.88，-0.19），与未接受转诊的患者相比。在宾夕法尼亚州，EHR-PT 转诊与医院 LOS 之间的关系尚不清楚。
结论
医疗系统应考虑采用方法，通过移动性评估促进急性护理医院的早期物理治疗转诊。
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