全美医院使用物理约束的情况:2011-2019

Ishaan Gupta MBBS, Ilana Nelson-Greenberg MD, Scott Mitchell Wright MD, Ché Matthew Harris MD, MS
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引用次数: 0

摘要

目标确定住院成人中物理约束(PR)使用率的变化及相关结果。患者和方法我们利用全国住院病人样本数据库,分析了 2011-2014 年和 2016-2019 年的数据,以确定 PR 的使用趋势。我们还对 2011-2012 年和 2018-2019 年进行了比较,以调查 PR 的使用率、院内死亡率、住院时间和医院总费用。1,538,791次(0.63%)有编码标识为PR,而241,455,319次(99.3%)没有。从 2011 年到 2014 年,PR 的使用显著增加(p-trend<.01),而从 2016 年到 2019 年,PR 率的增加并不显著(p-trend=.07)。随着时间的推移,PR 使用率有所增加(2011-2012 年:0.52% vs 2018-2019 年:0.73%;p<.01)。2011-2012年(调整赔率比 [aOR],3.9;95% CI,3.7-4.2;p<.01)和2018-2019年(aOR,3.5;95% CI,3.4-3.7;p<.01)使用PR的患者院内死亡率调整赔率较高。2011-2012年,PR患者的住院时间延长(调整后平均差异[aMD],4.3天;95% CI,4.1-4.5;p<.01),2018-2019年的住院时间更长(aMD,5.8天;95% CI,5.6-6.0;p<.01)。2011-2012 年 PR 患者的住院总费用更高(aMD,+55,003 美元;95% CI,49,309-60,679 美元;p<.01)。经通货膨胀调整后,2018-2019 年有 PR 患者的总费用仍高于无 PR 患者(aMD,+$70,018;95% CI,$65,355-$74,680;p<.01).结论总体而言,PR 率在整个研究期间并未下降,这表明最佳实践指南的宣传和颁布尚未转化为实践模式的实质性改变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Physical Restraint Usage in Hospitals Across the United States: 2011-2019

Objective

To determine the change in rates of physical restraint (PR) use and associated outcomes among hospitalized adults.

Patients and Methods

Using national inpatient sample databases, we analyzed years 2011-2014 and 2016-2019 to determine trends of PR usage. We also compared the years 2011-2012 and 2018-2019 to investigate rates of PR use, in-hospital mortality, length of stay, and total hospital charges.

Results

There were 242,994,110 hospitalizations during the study period. 1,538,791 (0.63%) had coding to signify PRs, compared with 241,455,319 (99.3%), which did not. From 2011 to 2014, there was a significant increase in PR use (p-trend<.01) and a nonsignificant increase in PR rates from 2016-2019 (p-trend=.07). Over time, PR use increased (2011-2012: 0.52% vs 2018-2019: 0.73%; p<.01). Patients with PRs reported a higher adjusted odds for in-hospital mortality in 2011-2012 (adjusted odds ratio [aOR], 3.9; 95% CI, 3.7-4.2; p<.01) and 2018-2019 (aOR, 3.5; 95% CI, 3.4-3.7; p<.01). Length of stay was prolonged for patients with PRs in 2011-2012 (adjusted mean difference [aMD], 4.3 days; 95% CI, 4.1-4.5; p<.01) and even longer in 2018-2019 (aMD, 5.8 days; 95% CI, 5.6-6.0; p<.01). Total hospital charges were higher for patients with PRs in 2011-2012 (aMD, +$55,003; 95% CI, $49,309-$60,679; p<.01). Following adjustment for inflation, total charges remained higher for patients with PRs compared with those without PRs in 2018-2019 (aMD, +$70,018; 95% CI, $65,355-$74,680; p<.01).

Conclusion

Overall, PR rates did not decrease across the study period, suggesting that messaging and promulgating best practice guidelines have yet to translate into a substantive change in practice patterns.

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来源期刊
Mayo Clinic proceedings. Innovations, quality & outcomes
Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy
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