School of Global Health Management and Informatics, University of Central Florida, Orlando, Florida, USA.
Social Science Department, University of Wisconsin-Stout, Menomonie, Wisconsin, USA.
Popul Health Manag. 2024 Jun;27(3):168-173. doi: 10.1089/pop.2023.0297. Epub 2024 Mar 28.
Advanced Care at Home is a Mayo Clinic hospital-at-home (HaH) program that provides hospital-level care for patients. The study examines patient- and community-level factors that influence health outcomes. The authors performed a retrospective study using patient data from July 2020 to December 2022. The study includes 3 Mayo Clinic centers and community-level data from the Agency for Healthcare Research and Quality. The authors conducted binary logistic regression analyses to examine the relationship among the independent variables (patient- and community-level characteristics) and dependent variables (30-day readmission, mortality, and escalation of care back to the brick-and-mortar hospital). The study examined 1433 patients; 53% were men, 90.58% were White, and 68.2% were married. The mortality rate was 2.8%, 30-day readmission was 11.4%, and escalation back to brick-and-mortar hospitals was 8.7%. At the patient level, older age and male gender were significant predictors of 30-day mortality (-value <0.05), older age was a significant predictor of 30-day readmission (-value <0.05), and severity of illness was a significant predictor for readmission, mortality, and escalation back to the brick-and-mortar hospital (-value <0.01). Patients with COVID-19 were less likely to experience readmission, mortality, or escalations (-value <0.05). At the community level, the Gini Index and internet access were significant predictors of mortality (-value <0.05). Race and ethnicity did not significantly predict adverse outcomes (-value >0.05). This study showed promise in equitable treatment of diverse patient populations. The authors discuss and address health equity issues to approximate the vision of inclusive HaH delivery.
居家高级护理是梅奥诊所的一种医院居家（HaH）项目，可为患者提供医院级别的护理。本研究考察了影响健康结果的患者和社区层面的因素。作者使用 2020 年 7 月至 2022 年 12 月期间的患者数据进行了回顾性研究。该研究包括梅奥诊所的 3 个中心和来自医疗保健研究和质量局的社区层面的数据。作者进行了二元逻辑回归分析，以研究独立变量（患者和社区特征）与因变量（30 天内再入院、死亡率和护理升级回到实体医院）之间的关系。该研究共纳入了 1433 名患者，其中 53%为男性，90.58%为白人，68.2%为已婚。死亡率为 2.8%，30 天内再入院率为 11.4%，升级回到实体医院的比例为 8.7%。在患者层面，年龄较大和男性是 30 天内死亡的显著预测因素（P 值<0.05），年龄较大是 30 天内再入院的显著预测因素（P 值<0.05），疾病严重程度是再入院、死亡和升级回到实体医院的显著预测因素（P 值<0.01）。患有 COVID-19 的患者再入院、死亡或升级的可能性较低（P 值<0.05）。在社区层面，基尼指数和互联网接入是死亡率的显著预测因素（P 值<0.05）。种族和民族与不良结果无显著相关性（P 值>0.05）。本研究表明，在治疗不同患者群体方面取得了一定的进展。作者讨论并解决了公平问题，以接近包容的 HaH 服务愿景。
