Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
BMJ Open Qual. 2024 Mar 19;13(1):e002289. doi: 10.1136/bmjoq-2023-002289.
The transitional period between hospital discharge and primary care follow-up is a vulnerable time for patients that can result in adverse health outcomes and preventable hospital readmissions. This is especially true for patients of safety-net hospitals (SNHs) who often struggle to secure primary care access when leaving the hospital due to social, economic and cultural barriers. In this study, we describe a resident-led postdischarge clinic that serves patients discharged from NYU Langone Hospital-Brooklyn, an urban safety-net academic hospital. In our multivariable analysis, there was no statistical difference in the readmission rate between those who completed the transitional care management and those who did not (OR 1.32 (0.75-2.36), p=0.336), but there was a statistically significant increase in primary care provider (PCP) engagement (OR 0.53 (0.45-0.62), p<0.001). Overall, this study describes a postdischarge clinic model embedded in a resident clinic in an urban SNH that is associated with increased PCP engagement, but no reduction in 30-day hospital readmissions.
患者从医院出院到接受初级保健随访的过渡时期是一个脆弱的时期,可能导致不良的健康结果和可预防的医院再入院。对于安全网医院 (SNH) 的患者来说尤其如此,由于社会、经济和文化障碍,他们往往在出院后难以获得初级保健。在这项研究中,我们描述了一个由住院医师领导的出院后诊所,为从布鲁克林纽约大学朗格尼医院出院的患者服务。在我们的多变量分析中,完成过渡护理管理的患者与未完成的患者的再入院率没有统计学差异(OR 1.32(0.75-2.36),p=0.336),但初级保健提供者(PCP)的参与度有统计学显著增加(OR 0.53(0.45-0.62),p<0.001)。总的来说,这项研究描述了一个位于城市 SNH 的住院医师诊所内嵌入的出院后诊所模式,该模式与增加 PCP 参与度相关,但与 30 天内医院再入院率降低无关。