Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; FOU nu, Research and Development Center for the Elderly, Region Stockholm, Järfälla, Sweden.
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; FOU nu, Research and Development Center for the Elderly, Region Stockholm, Järfälla, Sweden.
J Am Med Dir Assoc. 2024 Feb;25(2):215-222.e3. doi: 10.1016/j.jamda.2023.10.010. Epub 2023 Nov 18.
To describe the social services received by a 2016 Swedish cohort after discharge from inpatient geriatric care and to analyze the association between level of social services post-discharge and 30-day readmission.
Observational, closed-cohort study.
All patients admitted to 1 of 3 regionally operated inpatient geriatric care settings in Region Stockholm, Sweden, in 2016 (n = 7453).
Individual-level data from medical records and population registries were linked using unique personal identification numbers. Descriptive statistics were reported for 4 levels of municipal social services post-discharge: long-term care, 1 to 50 home help hours per month, >50 home help hours per month, and no home help. Multinomial logistic regression was performed to analyze the association between level of social services post-discharge and 3 outcomes within 30 days: readmission, death without readmission, or neither readmission nor death.
Results show that almost 11% of patients were discharged to long-term care and 54% received municipal home help services. Individuals with no municipal home help or with 1 to 50 hours per month were more likely to be readmitted within 30 days compared with those in long-term care. Living with more than 50 hours of help was not associated with an increased likelihood of 30-day readmission.
Patients who received inpatient geriatric care are significant users of municipal social services post-discharge. Living in long-term care or with extensive home help appears to be a protective factor in preventing readmission compared with more limited or no home help services. Care transitions for this frail patient group require careful social care planning. Supporting individuals discharged with fewer social service hours may help reduce readmissions.
描述 2016 年瑞典队列出院后接受的社会服务，并分析出院后社会服务水平与 30 天再入院之间的关系。
观察性、封闭队列研究。
所有在 2016 年入住瑞典斯德哥尔摩地区运营的 3 个地区性住院老年护理机构之一的患者（n=7453）。
使用唯一的个人身份号码将病历和人口登记处的个人数据进行链接。报告了出院后 4 个级别的市社会服务水平的描述性统计数据：长期护理、每月 1 至 50 小时的家庭帮助、每月超过 50 小时的家庭帮助和无家庭帮助。使用多项逻辑回归分析出院后社会服务水平与 30 天内 3 个结果之间的关系：再入院、无再入院死亡或两者均无。
结果表明，近 11%的患者出院后进入长期护理，54%的患者接受市家庭帮助服务。与长期护理相比，没有市家庭帮助或每月 1 至 50 小时的患者在 30 天内再入院的可能性更高。接受超过 50 小时帮助的患者与 30 天内再入院的可能性增加无关。
接受住院老年护理的患者是出院后市社会服务的主要使用者。与更有限或没有家庭帮助服务相比，生活在长期护理或接受广泛家庭帮助的患者似乎是预防再入院的保护因素。对于这个脆弱的患者群体，护理过渡需要仔细的社会护理规划。支持出院时社会服务小时数较少的患者可能有助于减少再入院。
