新颖的、由护士主导的早期出院后临床与再入院率和失代偿性肝硬化住院后死亡率降低相关

IF 2.4 Q3 GASTROENTEROLOGY & HEPATOLOGY
Benjamin Giles, Kirsty Fancey, Karen Gamble, Zeshan Riaz, Joanna K Dowman, Andrew J Fowell, Richard J Aspinall
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引用次数: 0

摘要

目的失代偿期肝硬化患者早期意外再入院率高。许多再入院可以避免与二级预防策略,但患者往往再入院之前门诊审查。为了解决这个问题,我们建立了一个新颖的,由护士领导的早期出院(EPD)诊所,为肝硬化并发症提供目标导向的护理,并评估了其影响。方法回顾性队列研究,比较78例EPD门诊患者和91例表型匹配的对照组接受标准的肝病专科医生治疗的结果。从指数入院开始随访12个月,终点包括生存、再入院时间、再入院次数和医疗负担。结果对照组再入院时间为51天,干预组再入院时间为98天(p < 0.01)。干预组在30天(12% vs 30%, p= 0.01)和90天(27% vs 49%, p= 0.01)的再入院率显著降低,但在12个月(58% vs 68%, p=0.16)时再入院率不显著降低,总卧床日使用率减少29%。对照组30天死亡率为4%,干预组无死亡病例。干预组在90天(5% vs 15%, p<0.05)和12个月(22% vs 41%, p<0.01)的死亡率显著减少。结论:在失代偿性肝硬化患者住院后,专科护士可以在肝病专家门诊复查之前有效地提供目标导向的出院后护理。该模型与再入院率显著降低、床日使用率降低和死亡率降低有关。我们的数据表明,这种护理模式值得更广泛的实施和进一步的评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Novel, nurse-led early postdischarge clinic is associated with fewer readmissions and lower mortality following hospitalisation with decompensated cirrhosis
Objective Patients hospitalised with decompensated cirrhosis have high rates of early unplanned readmission. Many readmissions are avoidable with secondary preventative strategies, but patients are often readmitted prior to outpatient review. To address this, we established a novel, nurse-led early postdischarge (EPD) clinic delivering goal-directed care for cirrhosis complications and evaluated the impact. Methods Retrospective cohort study comparing outcomes in 78 patients seen in the EPD clinic with 91 phenotypically matched controls receiving standard, consultant hepatologist care. Follow-up for 12 months from index admission with endpoints including survival, time to readmission, number of readmissions and healthcare burden. Results Median time to readmission was 51 days in controls and 98 days in the intervention group (p<0.01). The intervention cohort had significantly fewer readmissions at 30 days (12% vs 30%, p<0.01) and 90 days (27% vs 49%, p<0.01) but not significantly at 12 months (58% vs 68%, p=0.16) with an overall reduction in bed day usage of 29%. Mortality for the control group was 4% at 30 days with no deaths in the intervention group. There were significantly fewer deaths in the intervention group at 90 days (5% vs 15%, p<0.05) and 12 months (22% vs 41%, p<0.01). Conclusions Following an index hospitalisation with decompensated cirrhosis, goal-directed postdischarge care can be effectively delivered by specialist nurses, prior to outpatient review by hepatologists. This model was associated with significantly fewer readmissions, lower bed day usage and a reduced mortality. Our data suggest such models of care deserve wider implementation and further evaluation.
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来源期刊
Frontline Gastroenterology
Frontline Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.70
自引率
11.50%
发文量
93
期刊介绍: Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.
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