Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Respiratory-, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden.
Prim Health Care Res Dev. 2022 Dec 9;23:e78. doi: 10.1017/S1463423622000676.
Heart failure (HF) has a 2% prevalence in the population and is a major cause of morbidity and mortality. Multiple efforts have been made worldwide to improve quality of care and decrease unplanned readmissions for HF patients, one of which has been the introduction of specialist HF nurses (HFN) in primary health care. The present evidence on the benefits of HFN is contradicting. This study aims to evaluate the impact of a quality improvement intervention, availability of a HFN in Swedish primary care, on hospital readmissions.
All patients over the age of 65 with a HF diagnosis and with complete information on availability of a HFN were included in this retrospective register-based study. Using propensity score matching (PSM) techniques, two comparable groups of 128 patients each were created according to the exposure status, availability or no availability of a HFN. The rate of readmission was compared between the groups.
Using PSM, 256 patients were matched, 128 in the HFN group and 128 in the no-HFN group. A total of 50% and 46.09% of patients in the HFN and no-HFN groups were readmitted, respectively. Mean number of readmissions per patient was 1.19 (SD 0.61) in the HFN group and 1.10 (SD 0.44) in the no-HFN group. Patients in the HFN had 17.6% higher odds of being readmitted during the study period, OR: 1.176 (CI: 0.716-1.932), and 3.8% lower odds of being readmitted within 30 days, OR: 0.962 (CI: 0.528-1.750).
Availability of a HFN in primary care was not significantly associated with reduced readmissions for the patients included in this study. Further investigations are warranted looking at the impacts of availability and access to a HFN in primary care on readmissions and other patient outcomes.
心力衰竭（HF）在人群中的患病率为 2%，是发病率和死亡率的主要原因。全世界已经做出了多项努力来提高医疗质量并减少 HF 患者的非计划性再入院率，其中之一是在初级保健中引入专科 HF 护士（HFN）。目前关于 HFN 益处的证据存在矛盾。本研究旨在评估质量改进干预措施的效果，即在瑞典初级保健中提供 HFN 对住院再入院的影响。
本回顾性基于登记的研究纳入了所有年龄在 65 岁以上且 HF 诊断完整且有 HFN 可用性信息的患者。使用倾向评分匹配（PSM）技术，根据暴露状态，即 HFN 的可用性或不可用性，创建了两组各 128 名具有可比性的患者。比较两组之间的再入院率。
使用 PSM，共匹配了 256 名患者，HFN 组 128 名，无 HFN 组 128 名。HFN 组和无 HFN 组的患者再入院率分别为 50%和 46.09%。HFN 组每位患者的平均再入院次数为 1.19（SD 0.61），无 HFN 组为 1.10（SD 0.44）。在研究期间，HFN 组患者的再入院可能性高 17.6%，OR：1.176（CI：0.716-1.932），30 天内再入院的可能性低 3.8%，OR：0.962（CI：0.528-1.750）。
在本研究纳入的患者中，初级保健中 HFN 的可用性与再入院率的降低无显著相关性。需要进一步调查初级保健中 HFN 的可用性和可及性对再入院率和其他患者结局的影响。
