Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
BMJ Open Qual. 2022 Nov;11(4). doi: 10.1136/bmjoq-2022-001875.
At hospital discharge, care is handed over from providers to patients. Discharge encounters must prepare patients to self-manage their health, but have been found to be suboptimal. Our study objectives were to describe and determine the correlates of perceived discharge quality and to explore the association between perceived discharge quality and postdischarge outcomes.
We conducted a prospective cohort study in medical inpatients admitted to a tertiary care hospital in Calgary, Canada. Perceived discharge quality was measured by the Care Transitions Measure (CTM). Linkage to administrative databases provided data for the composite outcome-90-day hospital readmission or emergency department visit. Logistic regression modelling was used to determine the association between global CTM scores, and the individual CTM components, and the composite outcome.
A total of 316 patients were included in the analysis. The median CTM score was 80.0 (IQR 66.6-100.0). The distribution of CTM scores were significantly different based on comorbidity burden, with the median and maximum CTM scores being lower and the IQR being narrower, for those with six or more comorbidities compared with those with fewer comorbidities. CTM scores were not associated with the composite outcome, though a single CTM item-not understanding warning signs and symptoms-was (adjusted OR 3.46 (95% CI 1.02 to 11.73)).
Perceived quality of discharge varies based on patient burden of comorbidities. While global perceived discharge quality was not associated with postdischarge outcomes, lack of patient understanding of warning symptoms was. Discharging healthcare teams should pay special attention to these priority patient groups and specific discharge process components.
在出院时，医护人员将患者的护理工作转交给患者。出院交接必须使患者能够自我管理健康，但目前发现这种交接并不理想。我们的研究目的是描述和确定感知出院质量的相关因素，并探讨感知出院质量与出院后结果之间的关系。
我们在加拿大卡尔加里的一家三级保健医院进行了一项前瞻性队列研究。感知出院质量通过护理过渡量表（CTM）进行测量。与行政数据库的链接提供了 90 天内住院再入院或急诊就诊的复合结局数据。逻辑回归模型用于确定全球 CTM 评分、CTM 各个组成部分与复合结局之间的关联。
共纳入 316 名患者进行分析。CTM 评分中位数为 80.0（IQR 66.6-100.0）。根据合并症负担，CTM 评分的分布差异具有统计学意义，具有 6 种或更多合并症的患者的中位数和最大值 CTM 评分较低，IQR 较窄，而合并症较少的患者则相反。CTM 评分与复合结局无关，尽管单个 CTM 项目-不了解警告症状和体征-有关（调整后的 OR 3.46（95%CI 1.02 至 11.73））。
感知出院质量因患者合并症负担而异。尽管整体感知出院质量与出院后结果无关，但患者对警告症状的理解不足。出院医疗团队应特别关注这些重点患者群体和特定的出院流程环节。
