患者、其重要他人和医疗保健专业人员评估的老年住院患者非计划性再入院相关因素的流行情况：一项横断面调查。
Prevalence of factors contributing to unplanned hospital readmission of older medical patients when assessed by patients, their significant others and healthcare professionals: a cross-sectional survey.
机构信息
Department of Research, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark.
Department of Medicine, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark.
出版信息
Eur Geriatr Med. 2023 Aug;14(4):823-835. doi: 10.1007/s41999-023-00799-6. Epub 2023 May 24.
OBJECTIVE
To describe the prevalence of factors contributing to readmission of older medical patients perceived by patients, significant others and healthcare professionals and to examine the agreement of factors contributing to readmission.
METHODS
This cross-sectional survey was conducted at Horsens Regional Hospital from September 2020 to June 2021. Patients aged ≥ 65 years and who were readmitted within 30 days were included. The questionnaire covered eight themes: disease; diagnosing, treatment and care; network; organisation; communication; skills and knowledge; resources; and practical arrangements. Response groups were patients, significant others, GPs, district nurses and hospital physicians. Outcomes were the prevalence of factors contributing to 30-day readmission and inter-rater agreement between respondents.
RESULTS
In total, 165 patients, 147 significant others, 115 GPs, 75 district nurses and 165 hospital physicians were included. The patients' median age was 79 years (IQR 74-85), and 44% were women. The following were the most prevalent contributing factors: (1) relapse of the condition that caused the index admission, (2) the patient could not manage the symptoms or illness, (3) worsening of other illnesses or conditions, (4) the patient was not fully treated at the time of discharge and (5) the patient's situation was too complex for the medical practice to handle. Kappas ranged from 0.0142 to 0.2421 for patient-significant other dyads and 0.0032 to 0.2459 for GP-hospital physician dyads.
CONCLUSION
From the perspectives of the included respondents, factors associated with the disease and its management were the most prevalent contributors to readmission for older medical patients. Agreement on the contributing factors was generally low.
TRIAL REGISTRATION
Clinical trial number NCT05116644. Registration date October 27, 2021.
目的
描述患者、重要他人和医疗保健专业人员认为导致老年住院患者再入院的因素的流行情况，并检验导致再入院的因素是否存在一致性。
方法
本横断面调查于 2020 年 9 月至 2021 年 6 月在 Horsens 地区医院进行。纳入年龄≥65 岁且在 30 天内再次入院的患者。问卷涵盖了 8 个主题：疾病；诊断、治疗和护理；网络；组织；沟通；技能和知识；资源；以及实际安排。受访者包括患者、重要他人、全科医生、地区护士和医院医生。结果为导致 30 天内再入院的因素的流行情况和受访者之间的评分者间一致性。
结果
共纳入 165 名患者、147 名重要他人、115 名全科医生、75 名地区护士和 165 名医院医生。患者的中位年龄为 79 岁（IQR 74-85），44%为女性。以下是最常见的促成因素：（1）导致入院的疾病复发；（2）患者无法管理症状或疾病；（3）其他疾病或病情恶化；（4）患者出院时未得到充分治疗；（5）患者的情况过于复杂，医疗实践无法处理。患者-重要他人对之间的 Kappa 值范围为 0.0142 至 0.2421，全科医生-医院医生对之间的 Kappa 值范围为 0.0032 至 0.2459。
结论
在所纳入的受访者看来，与疾病及其管理相关的因素是导致老年住院患者再入院的最常见原因。对促成因素的一致性总体较低。
试验注册
临床试验编号 NCT05116644。注册日期 2021 年 10 月 27 日。
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