Solomon D H, Wagner D R, Marenberg M E, Acampora D, Cooney L M, Inouye S K
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
J Am Geriatr Soc. 1993 Sep;41(9):961-6. doi: 10.1111/j.1532-5415.1993.tb06762.x.
To prospectively study the incidence of and risk factors for home health care (HHC) use in a cohort of elderly medical and surgical patients discharged from acute care. Although HHC is commonly received by patients in this group, its predictors have not been well studied.
Prospective cohort study.
Medical and surgical wards at a university teaching hospital, followed by 23 Medicare-certified HHC agencies in the study catchment area.
226 medical and surgical patients aged 70 years and older immediately after discharge from acute care.
HHC initiated within 14 days after hospital discharge, measured by direct review of HHC agency records.
The incidence of HHC initiated within 2 weeks post-discharge was 75/226 (34%). The median duration of service was 30 days (range 3-483) with a median of 3 visits per week. Four independent predictors of HHC were identified through multivariate analysis: educational level < or = 12 years (relative risk (RR) 3.3; 95% confidence interval (CI) 1.6 to 6.6); less accessible social support (RR, 1.7; CI 0.9 to 3.1); impairment in at least one instrumental activity of daily living (RR, 1.9; CI, 1.0, 3.4); and prior HHC use (RR, 2.1; CI, 1.2 to 3.6). Risk strata were created by adding one point for each risk factor present: with 0-1 risk factors, 8% used HHC; with two risk factors, 28%; with three risk factors, 45%, with four risk factors, 76%. This trend was statistically significant (P < 0.001).
HHC use is common among elderly patients after discharge from acute care. A simple predictive model based on four risk factors can be used on admission to predict HHC use. This model may be useful for discharge planning and health care utilization planning for the elderly population.
前瞻性研究一组从急症护理机构出院的老年内科和外科患者接受家庭医疗保健（HHC）的发生率及危险因素。虽然该组患者普遍接受HHC，但对其预测因素尚未进行充分研究。
前瞻性队列研究。
一所大学教学医院的内科和外科病房，随后由研究集水区内23家获得医疗保险认证的HHC机构跟进。
226名年龄在70岁及以上的内科和外科患者，刚从急症护理机构出院。
通过直接查阅HHC机构记录，测量出院后14天内启动的HHC。
出院后2周内启动HHC的发生率为75/226（34%）。服务的中位持续时间为30天（范围3 - 483天），每周中位就诊次数为3次。通过多变量分析确定了HHC的四个独立预测因素：教育程度≤12年（相对风险（RR）3.3；95%置信区间（CI）1.6至6.6）；社会支持较难获得（RR，1.7；CI 0.9至3.1）；至少一项日常生活工具性活动受损（RR，1.9；CI，1.0，3.4）；以及既往使用过HHC（RR，2.1；CI，1.2至3.6）。通过为每个存在的危险因素加1分来创建风险分层：有0 - 1个危险因素的患者，8%使用HHC；有两个危险因素的患者，28%；有三个危险因素的患者，45%；有四个危险因素的患者，76%。这种趋势具有统计学意义（P < 0.001）。
HHC在老年患者从急症护理机构出院后很常见。基于四个危险因素的简单预测模型可在入院时用于预测HHC的使用情况。该模型可能对老年人群的出院计划和医疗保健利用规划有用。
