Britton Cameron J, Potretzke Aaron M, Liaw Christine, Ahmed Mohamed E, Manka Madeleine G, Wymer Kevin M, Alom Manaf, Linder Brian J, Koo Kevin, Klett Dane E
Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Urology, Creighton University, Omaha, Nebraska, USA.
Can J Urol. 2023 Apr;30(2):11480-11486.
We aimed to assess the impact of discharge instruction (DCI) readability on 30-day postoperative contact with the healthcare system.
Utilizing a multidisciplinary team, DCI were modified for patients undergoing cystoscopy, retrograde pyelogram, ureteroscopy, laser lithotripsy, and stent placement (CRULLS) from a 13th grade to a 7th grade reading level. We retrospectively reviewed 100 patients including 50 consecutive patients with original DCI (oDCI) and 50 consecutive patients with improved readability DCI (irDCI). Clinical and demographic data collected including healthcare system contact (communications [phone or electronic message], emergency department [ED], and unplanned clinic visits) within 30 days of surgery. Uni/multivariate logistic regression analyses used to identify factors, including DCI-type, associated with increased healthcare system contact. Findings reported as odds ratios with 95% confidence intervals and p values (< 0.05 significant).
There were 105 contacts to the healthcare system within 30 days of surgery: 78 communications, 14 ED visits and 13 clinic visits. There were no significant differences between cohorts in the proportion of patients with communications (p = 0.16), ED visits (p =1.0) or clinic visits (p = 0.37). On multivariable analysis, older age and psychiatric diagnosis were associated with significantly increased odds of overall healthcare contact (p = 0.03 and p = 0.04) and communications (p = 0.02 and p = 0.03). Prior psychiatric diagnosis was also associated with significantly increased odds of unplanned clinic visits (p = 0.003). Overall, irDCI were not significantly associated with the endpoints of interest.
Increasing age and prior psychiatric diagnosis, but not irDCI, were significantly associated with an increased rate of healthcare system contact following CRULLS.
我们旨在评估出院指导（DCI）的可读性对术后30天内与医疗系统接触情况的影响。
利用多学科团队，将接受膀胱镜检查、逆行肾盂造影、输尿管镜检查、激光碎石术和支架置入术（CRULLS）患者的DCI从13年级阅读水平修改为7年级阅读水平。我们回顾性分析了100例患者，其中包括50例连续使用原始DCI（oDCI）的患者和50例连续使用可读性得到改善的DCI（irDCI）的患者。收集的临床和人口统计学数据包括手术30天内与医疗系统的接触情况（沟通[电话或电子信息]、急诊科[ED]和非计划内门诊就诊）。采用单因素/多因素逻辑回归分析来确定与医疗系统接触增加相关的因素，包括DCI类型。研究结果以比值比及95%置信区间和p值（<0.05为显著）报告。
术后30天内有105次与医疗系统的接触：78次沟通、14次ED就诊和13次门诊就诊。两组患者在沟通比例（p = 0.16）、ED就诊比例（p = 1.0）或门诊就诊比例（p = 0.37）方面无显著差异。多因素分析显示，年龄较大和有精神疾病诊断与总体医疗接触（p = 0.03和p = 0.04）及沟通（p = 0.02和p = 0.03）的几率显著增加相关。既往精神疾病诊断也与非计划内门诊就诊几率显著增加相关（p = 0.003）。总体而言，irDCI与感兴趣的终点无显著关联。
年龄增加和既往精神疾病诊断与CRULLS术后医疗系统接触率增加显著相关，但irDCI并非如此。
