Diem S J, Prochazka A V, Meyer T J, Fryer G E
Section of Ambulatory Care, Durham Veterans Affairs Medical Center, NC 27705, USA.
J Gen Intern Med. 1996 Mar;11(3):179-81. doi: 10.1007/BF02600273.
This randomized, controlled clinical trial evaluated the effect of a postdischarge clinic on housestaff education and patient utilization of hospital services. Medicine housestaff were randomized either to attend a clinic once a week in which they saw all eligible patients they had recently discharged from the hospital, or to continue with usual discharge practices. We enrolled 751 patients, 312 on intervention teams and 439 on control teams. Intervention housestaff did not feel that the clinic took too much time and felt that they better knew how patients did after discharge. Fewer intervention patients had emergency room visits (28.0% to 20.8%, p = .03) in the 30 days after discharge. Length of stay, readmission rates, and mortality were similar for the two groups. We conclude that a postdischarge clinic can improve resident education and reduce postdischarge emergency room utilization.
这项随机对照临床试验评估了出院后门诊对住院医师教育及患者医院服务利用情况的影响。内科住院医师被随机分为两组，一组每周参加一次门诊，负责诊治他们近期从医院出院的所有符合条件的患者，另一组则继续常规出院流程。我们招募了751名患者，其中312名在干预组，439名在对照组。干预组住院医师并不觉得门诊花费时间过多，且认为他们对患者出院后的情况有了更好的了解。出院后30天内，干预组患者急诊就诊的比例更低（从28.0%降至20.8%，p = 0.03）。两组患者的住院时间、再入院率及死亡率相似。我们得出结论，出院后门诊可改善住院医师教育，并减少出院后急诊的利用。
