Konstantin Georgiev, Dimitrios Doudesis, Joanne McPeake, Nicholas L Mills, Jacques Fleuriot, Susan D Shenkin, Atul Anand
{"title":"利用电子健康记录了解 COVID-19 患者和无 COVID-19 患者的医院康复情况。","authors":"Konstantin Georgiev, Dimitrios Doudesis, Joanne McPeake, Nicholas L Mills, Jacques Fleuriot, Susan D Shenkin, Atul Anand","doi":"10.1186/s12913-024-11665-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Many hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from Electronic Health Records (EHR) to report the quantity and intensity of rehabilitation required to achieve hospital discharge, comparing patients with and without COVID-19.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of consecutive adults in whom COVID-19 testing was undertaken between March 2020 and August 2021 across three acute hospitals in Scotland. We defined rehabilitation contacts (physiotherapy, occupational therapy, dietetics and speech and language therapy) from timestamped EHR data and determined contact time from a linked workforce planning dataset. Our aim was to clarify rehabilitation required to achieve hospital discharge and so we excluded patients who died during their admission, and those who did not require rehabilitation (fewer than two specialist contacts). The primary outcome was total rehabilitation time. Secondary outcomes included the number of contacts, admission to first contact, and rehabilitation minutes per day. A multivariate regression analysis for identifying patient characteristics associated with rehabilitation time included age, sex, comorbidities, and socioeconomic status.</p><p><strong>Results: </strong>We included 11,591 consecutive unique patient admissions (76 [63,85] years old, 56% female), of which 651 (6%) were with COVID-19, and 10,940 (94%) were admissions with negative testing. There were 128,646 rehabilitation contacts. Patients with COVID-19 received more than double the rehabilitation time compared to those without (365 [165, 772] vs 170 [95, 350] mins, p<0.001), and this was delivered over more specialist contacts (12 [6, 25] vs 6 [3, 11], p<0.001). Admission to first rehabilitation contact was later in patients with COVID-19 (3 [1, 5] vs 2 [1, 4] days from admission). Overall, patients with COVID-19 received fewer minutes of rehabilitation per day of admission (14.1 [9.8, 18.7] vs 15.6 [10.6, 21.3], p<0.001). In our regression analyses, older age and COVID-19 were associated with increased rehabilitation time.</p><p><strong>Conclusions: </strong>Patients with COVID received more rehabilitation contact time than those without COVID, but this was delivered less intensively and was commenced later in an admission. Rehabilitation data derived from the EHR represents a novel measure of delivered hospital care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484221/pdf/","citationCount":"0","resultStr":"{\"title\":\"Understanding hospital rehabilitation using electronic health records in patients with and without COVID-19.\",\"authors\":\"Konstantin Georgiev, Dimitrios Doudesis, Joanne McPeake, Nicholas L Mills, Jacques Fleuriot, Susan D Shenkin, Atul Anand\",\"doi\":\"10.1186/s12913-024-11665-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Many hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from Electronic Health Records (EHR) to report the quantity and intensity of rehabilitation required to achieve hospital discharge, comparing patients with and without COVID-19.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of consecutive adults in whom COVID-19 testing was undertaken between March 2020 and August 2021 across three acute hospitals in Scotland. We defined rehabilitation contacts (physiotherapy, occupational therapy, dietetics and speech and language therapy) from timestamped EHR data and determined contact time from a linked workforce planning dataset. Our aim was to clarify rehabilitation required to achieve hospital discharge and so we excluded patients who died during their admission, and those who did not require rehabilitation (fewer than two specialist contacts). The primary outcome was total rehabilitation time. Secondary outcomes included the number of contacts, admission to first contact, and rehabilitation minutes per day. A multivariate regression analysis for identifying patient characteristics associated with rehabilitation time included age, sex, comorbidities, and socioeconomic status.</p><p><strong>Results: </strong>We included 11,591 consecutive unique patient admissions (76 [63,85] years old, 56% female), of which 651 (6%) were with COVID-19, and 10,940 (94%) were admissions with negative testing. There were 128,646 rehabilitation contacts. Patients with COVID-19 received more than double the rehabilitation time compared to those without (365 [165, 772] vs 170 [95, 350] mins, p<0.001), and this was delivered over more specialist contacts (12 [6, 25] vs 6 [3, 11], p<0.001). Admission to first rehabilitation contact was later in patients with COVID-19 (3 [1, 5] vs 2 [1, 4] days from admission). Overall, patients with COVID-19 received fewer minutes of rehabilitation per day of admission (14.1 [9.8, 18.7] vs 15.6 [10.6, 21.3], p<0.001). In our regression analyses, older age and COVID-19 were associated with increased rehabilitation time.</p><p><strong>Conclusions: </strong>Patients with COVID received more rehabilitation contact time than those without COVID, but this was delivered less intensively and was commenced later in an admission. Rehabilitation data derived from the EHR represents a novel measure of delivered hospital care.</p>\",\"PeriodicalId\":9012,\"journal\":{\"name\":\"BMC Health Services Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-10-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484221/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Health Services Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12913-024-11665-x\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Health Services Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12913-024-11665-x","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Understanding hospital rehabilitation using electronic health records in patients with and without COVID-19.
Background: Many hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from Electronic Health Records (EHR) to report the quantity and intensity of rehabilitation required to achieve hospital discharge, comparing patients with and without COVID-19.
Methods: We performed a retrospective cohort study of consecutive adults in whom COVID-19 testing was undertaken between March 2020 and August 2021 across three acute hospitals in Scotland. We defined rehabilitation contacts (physiotherapy, occupational therapy, dietetics and speech and language therapy) from timestamped EHR data and determined contact time from a linked workforce planning dataset. Our aim was to clarify rehabilitation required to achieve hospital discharge and so we excluded patients who died during their admission, and those who did not require rehabilitation (fewer than two specialist contacts). The primary outcome was total rehabilitation time. Secondary outcomes included the number of contacts, admission to first contact, and rehabilitation minutes per day. A multivariate regression analysis for identifying patient characteristics associated with rehabilitation time included age, sex, comorbidities, and socioeconomic status.
Results: We included 11,591 consecutive unique patient admissions (76 [63,85] years old, 56% female), of which 651 (6%) were with COVID-19, and 10,940 (94%) were admissions with negative testing. There were 128,646 rehabilitation contacts. Patients with COVID-19 received more than double the rehabilitation time compared to those without (365 [165, 772] vs 170 [95, 350] mins, p<0.001), and this was delivered over more specialist contacts (12 [6, 25] vs 6 [3, 11], p<0.001). Admission to first rehabilitation contact was later in patients with COVID-19 (3 [1, 5] vs 2 [1, 4] days from admission). Overall, patients with COVID-19 received fewer minutes of rehabilitation per day of admission (14.1 [9.8, 18.7] vs 15.6 [10.6, 21.3], p<0.001). In our regression analyses, older age and COVID-19 were associated with increased rehabilitation time.
Conclusions: Patients with COVID received more rehabilitation contact time than those without COVID, but this was delivered less intensively and was commenced later in an admission. Rehabilitation data derived from the EHR represents a novel measure of delivered hospital care.
期刊介绍:
BMC Health Services Research is an open access, peer-reviewed journal that considers articles on all aspects of health services research, including delivery of care, management of health services, assessment of healthcare needs, measurement of outcomes, allocation of healthcare resources, evaluation of different health markets and health services organizations, international comparative analysis of health systems, health economics and the impact of health policies and regulations.