A time-series analysis examining implementation strategies to increase use of an early-supported discharge hospital at home model

IF 2.4 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine Pub Date : 2024-10-08 DOI:10.1002/jhm.13525

Padageshwar Sunkara MD, MMCi, Raghava Nagaraj MD, MPH, Hieu Nguyen MS, Stephanie Murphy DO, Kevin Goslen MD, Harsh Barot MD, Timothy Hetherington MS, Casey Stephens MPH, McKenzie Isreal MPH, Marc Kowalkowski PhD

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引用次数: 0

Abstract

Background

Early-supported discharge (ESD) hospital-at-home (HaH) programs facilitate hospitalized patients to receive ongoing acute-level care at home, thereby promoting patient-centeredness while improving hospital throughput.

Objectives

The current study aimed to test multiple implementation strategies to increase and sustain HaH ESD utilization.

Methods

We conducted interrupted time series analyses to evaluate the effectiveness of implementation strategies on weekly HaH ESD referrals and capacity utilization at five hospitals. Intervention 1 included provider-focused education and HaH nurse navigator support (July 2021 to May 2022). Intervention 2 added provider-level referral performance feedback and daily electronic health record-based eligibility reports (May 2022 to December 2022). During postintervention (January 2023 to June 2023), implementation strategies were no longer supported by the study team. Clinical outcomes were assessed over time and between patient subgroups.

Results

There were 5951 HaH ESD patients overall. After Intervention 2, we observed immediate increases in weekly HaH ESD referrals (level change mean difference [MD, 95% confidence interval]: 14.8, 5.9–23.6) and capacity utilization (level change MD: 13.9%, 6.2%–21.5%) and additional week-to-week increases in capacity utilization (slope change MD: 0.6%, 0.2%–0.9%), compared to Intervention 1 trends. HaH ESD referrals and capacity utilization were sustained postintervention. The proportion of provider-initiated referrals increased over time (Intervention 1: 79.4%, Intervention 2: 90.9%, postintervention: 95.2%). As HaH ESD utilization increased, we observed shorter inpatient length of stay and fewer HaH ESD encounters per visit (p < 0.01). There were small, statistically significant differences in 30-day mortality and readmission for residents of rural and socioeconomically disadvantaged areas.

Conclusion

Applying referral-focused provider feedback and daily eligibility reports were effective within a multicomponent approach to increase and sustain HaH ESD utilization.

Abstract Image

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一项时间序列分析，研究了提高早期支持出院在家模式使用率的实施策略。

背景：早期支持出院（ESD）住院-回家（HaH）计划有助于住院患者在家中接受持续的急性期护理，从而在提高医院吞吐量的同时促进以患者为中心：目前的研究旨在测试多种实施策略，以提高并维持 HaH ESD 的使用率：我们进行了间断时间序列分析，以评估五家医院的实施策略对每周HaH ESD转诊率和产能利用率的影响。干预 1 包括以医疗服务提供者为重点的教育和 HaH 护士导航员支持（2021 年 7 月至 2022 年 5 月）。干预 2 增加了医疗服务提供者层面的转诊绩效反馈和基于电子健康记录的每日资格报告（2022 年 5 月至 2022 年 12 月）。干预后（2023 年 1 月至 2023 年 6 月），研究团队不再支持实施策略。对不同时期和不同患者亚群的临床结果进行了评估：总共有 5951 名 HaH ESD 患者。与干预措施 1 的趋势相比，干预措施 2 后，我们观察到每周 HaH ESD 转诊量（平均差值水平变化[MD, 95% 置信区间]：14.8, 5.9-23.6）和医疗能力利用率（平均差值水平变化[MD]：13.9%, 6.2%-21.5%）立即增加，医疗能力利用率每周之间也有增加（平均差值水平变化[MD]：0.6%, 0.2%-0.9%）。干预后，哈医大公共卫生服务转诊率和能力利用率保持不变。医疗服务提供者发起的转诊比例随着时间的推移而增加（干预 1：79.4%；干预 2：90.9%；干预后：95.2%）。随着 HaH ESD 使用率的增加，我们观察到住院时间缩短，每次就诊的 HaH ESD 人次减少（p 结论：随着 HaH ESD 使用率的增加，我们观察到住院时间缩短，每次就诊的 HaH ESD 人次减少：以转诊为重点的医疗服务提供者反馈和每日资格报告是提高和维持血液透析ESD使用率的有效方法。

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

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.