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老年人再次前往急诊科就诊的相关因素:一项横断面分析研究。

Factors Associated with Re-attendance at Emergency Departments Among Older Adults: A Cross-Sectional Analytical Study.

作者信息

Janda Saengdao, Sansuk Juree

机构信息

Praboromarajchanok Institute, Khon Kaen, Thailand.

出版信息

Inquiry. 2025 Jan-Dec;62:469580251349652. doi: 10.1177/00469580251349652. Epub 2025 Jun 24.

Abstract

Emergency department (ED) re-attendance among older adults is an increasing global concern, often reflecting gaps in chronic disease management, discharge planning, and continuity of care. This study aimed to determine the frequency of ED re-attendance and identify associated patient- and system-level factors. A cross-sectional analytical study was conducted between July 2023 and August 2024 across general and community hospitals. A total of 740 participants were selected using multi-stage sampling, comprising 400 older adult patients and 340 healthcare professionals. Data were collected from medical records and structured questionnaires. Descriptive statistics and multiple logistic regression were applied to identify factors linked to ED re-attendance within 60 days. Among older adults, 35% revisited the ED within 60 days post-discharge. Key factors significantly associated with re-attendance included prior ED visits (OR = 3.92; 95% CI: 2.11-7.31), hospitalization within the previous year (OR = 1.97; 95% CI: 1.15-3.38), no follow-up with specialists (OR = 2.27; 95% CI: 1.35-3.83), and treatment at M2-level hospitals (OR = 7.28; 95% CI: 3.62-14.64). Targeted strategies to improve discharge processes, ensure specialist follow-up, and enhance primary care coordination are essential to reduce potentially avoidable ED re-attendance among older adults.

摘要

老年人再次前往急诊科就诊是一个日益受到全球关注的问题,这往往反映出慢性病管理、出院计划和护理连续性方面存在的差距。本研究旨在确定再次前往急诊科就诊的频率,并识别相关的患者层面和系统层面因素。2023年7月至2024年8月期间,在综合医院和社区医院开展了一项横断面分析研究。采用多阶段抽样共选取了740名参与者,其中包括400名老年患者和340名医护人员。数据从医疗记录和结构化问卷中收集。应用描述性统计和多元逻辑回归来识别与60天内再次前往急诊科就诊相关的因素。在老年人中,35%在出院后60天内再次前往急诊科。与再次就诊显著相关的关键因素包括之前去过急诊科(比值比[OR]=3.92;95%置信区间[CI]:2.11-7.31)、上一年住院(OR=1.97;95%CI:1.15-3.38)、未接受专科医生随访(OR=2.27;95%CI:1.35-3.83)以及在二级医院接受治疗(OR=7.28;95%CI:3.62-14.64)。采取有针对性的策略来改善出院流程、确保专科医生随访以及加强初级保健协调,对于减少老年人中潜在可避免的再次前往急诊科就诊至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70ff/12188085/8da2d8d501ec/10.1177_00469580251349652-fig1.jpg

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