Targeted care coordination towards patients with a history of multiple readmissions effectively reduces readmissions.

IF 2.4 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Family practice Pub Date : 2024-06-12 DOI:10.1093/fampra/cmad009

Courtney D Wellman, Adam M Franks, Morgan Stickler, William Rollyson, Alperen Korkmaz, Matthew Q Christiansen, Stephen M Petrany

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引用次数: 0

Abstract

Background: To decrease hospital readmission rates, clinical practices create a transition of care (TOC) process to assess patients and coordinate care postdischarge. As current evidence suggests lack of universal benefit, this study's objectives are to determine what patient and process factors associate with hospital readmissions, as well as construct a model to decrease 30-day readmissions.

Methods: Three months of retrospective discharged patient data (n = 123) were analysed for readmission influences including: patient-specific comorbidities, admission-specific diagnoses, and TOC components. A structured intervention of weekly contact, the Care Coordination Cocoon (CCC), was created for multiply readmitted patients (MRPs), defined as ≥2 readmissions. Three months of postintervention data (n = 141) were analysed. Overall readmission rates and patient- and process-specific characteristics were analysed for associations with hospital readmission.

Results: Standard TOC lacked significance. Patient-specific comorbidities of cancer (odds ratio [OR] 6.27; 95% confidence interval [CI] 1.73-22.75) and coronary artery disease (OR 6.71; 95% CI 1.84-24.46), and admission-specific diagnoses within pulmonary system admissions (OR 7.20; 95% CI 1.96-26.41) were associated with readmissions. Post-CCC data demonstrated a 48-h call (OR 0.21; 95% CI 0.09-0.50), answered calls (OR 0.16; CI 0.07-0.38), 14-day scheduled visit (OR 0.20; 95% CI 0.07-0.54), and visit arrival (OR 0.39; 95% CI 0.17-0.91) independently associated with decreased readmission rate. Patient-specific (hypertension-OR 3.65; CI 1.03-12.87) and admission-specific (nephrologic system-OR 3.22; CI 1.02-10.14) factors associated with readmissions which differed from the initial analysis.

Conclusions: Targeting a practice's MRPs with CCC resources improves the association of TOC components with readmissions and rates decreased. This is a more efficient use of TOC resources.

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对有多次再入院史的患者进行有针对性的护理协调，可有效减少再入院率。

背景：为了降低再入院率，临床实践建立了护理过渡（TOC）流程，以评估患者并协调出院后的护理。由于目前的证据表明这种方法缺乏普遍效益，因此本研究的目的是确定哪些患者和流程因素与再入院率有关，并构建一个减少 30 天再入院率的模型：方法：对三个月的回顾性出院患者数据（n = 123）进行分析，以确定再入院的影响因素，包括：患者特定的合并症、入院特定的诊断和 TOC 成分。针对再入院次数≥2 次的患者（MRPs）制定了每周联系的结构化干预措施--护理协调茧（CCC）。对干预后三个月的数据（n = 141）进行了分析。分析了再入院率的总体情况以及患者和治疗过程的特异性特征与再入院率的关系：结果：标准 TOC 缺乏显著性。患者特异性合并症癌症（几率比 [OR] 6.27；95% 置信区间 [CI] 1.73-22.75）和冠状动脉疾病（OR 6.71；95% CI 1.84-24.46）以及肺部系统入院的入院特异性诊断（OR 7.20；95% CI 1.96-26.41）与再入院率相关。CCC 后的数据显示，48 小时呼叫（OR 0.21；95% CI 0.09-0.50）、接听电话（OR 0.16；CI 0.07-0.38）、14 天预定就诊（OR 0.20；95% CI 0.07-0.54）和就诊到达（OR 0.39；95% CI 0.17-0.91）与再入院率的降低独立相关。患者特异性因素（高血压-OR 3.65；CI 1.03-12.87）和入院特异性因素（肾病系统-OR 3.22；CI 1.02-10.14）与再入院率相关，这些因素与最初的分析有所不同：结论：将 CCC 资源用于实践中的 MRPs，可改善 TOC 组成部分与再入院率的相关性，并降低再入院率。这是对 TOC 资源的更有效利用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Family practice 医学-医学：内科

CiteScore

4.30

自引率

9.10%

发文量

144

审稿时长

4-8 weeks

期刊介绍： Family Practice is an international journal aimed at practitioners, teachers, and researchers in the fields of family medicine, general practice, and primary care in both developed and developing countries. Family Practice offers its readership an international view of the problems and preoccupations in the field, while providing a medium of instruction and exploration. The journal''s range and content covers such areas as health care delivery, epidemiology, public health, and clinical case studies. The journal aims to be interdisciplinary and contributions from other disciplines of medicine and social science are always welcomed.