Evans R L, Hendricks R D
Department of Veteran Affairs, Seattle, WA.
Med Care. 1993 Apr;31(4):358-70. doi: 10.1097/00005650-199304000-00007.
To select patients for early discharge planning, a randomized clinical trial evaluated a protocol that used risk factors identified upon hospital admission. The goal of the study was to determine if intervention with high-risk patients could reduce the need for hospital admission or skilled care. Of 13,255 patients screened, 835 study participants were identified as "at risk" for frequent health care resource use. Half of the high-risk patients were randomly assigned to the experimental group (n = 417) and received discharge planning from day 3 of their hospital stay, while the control group (n = 418) received discharge planning only if there was a written physician request. Those patients receiving early, systematic discharge planning experienced an increased likelihood of successful return to home after hospital admission and a decreased chance of unscheduled readmission for the 9-month study period. Length of the index hospital stay was not affected by early planning, however. The major clinical implication is the potential for discharge planners to decrease the need for, and use of, health care resources after hospital admission.
为了选择适合早期出院计划的患者，一项随机临床试验评估了一种使用入院时确定的风险因素的方案。该研究的目的是确定对高危患者进行干预是否可以减少住院或接受专业护理的需求。在筛查的13255名患者中，835名研究参与者被确定为频繁使用医疗资源的“高危”患者。一半的高危患者被随机分配到实验组（n = 417），从住院第3天开始接受出院计划，而对照组（n = 418）只有在有医生书面要求时才接受出院计划。在9个月的研究期内，那些接受早期、系统出院计划的患者成功出院回家的可能性增加，非计划再入院的几率降低。然而，首次住院时间不受早期计划的影响。主要的临床意义在于，出院计划制定者有可能减少患者出院后对医疗资源的需求和使用。
