急诊科实施心房颤动决策辅助护理途径可减少心房颤动住院。

IF 6.9 2区 医学
Anil K Gehi, Tiffany Armbruster, Jennifer Walker, Lindsey Rosman, Jeffrey Laux, Ari Becker, Oludamilola Aladesanmi, Anthony J Mazzella, Zachariah Deyo, Kevin Biese
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引用次数: 0

摘要

背景:开发了一种直接的决策辅助工具,用于指导急诊科(ED)心房颤动(AF)患者的处置,供ED提供者使用。教育部尚未对这一决策援助的实施情况进行研究。方法:采用实用的阶梯式楔形聚类方法对回顾性收集的电子健康记录数据进行分析,在最初的1年基线评估后,选择5家医院定期开始干预,另外5家医院被纳入对照组(均在北卡罗来纳州)。分析的主要终点是住院率。在控制预先指定的患者和医院预测因素的同时,在医院层面进行分层多变量逻辑回归分析,将入院作为干预的函数。结果:2017年10月至2020年5月,共有11 458名患者(平均年龄71.4岁;50.5%女性)在10家医院中的1家医院接受了房颤的初步诊断。干预后,绝对入院率从60.5%降至48.3%(优势比,0.83[95%CI,0.71-0.97];P=0.016)。调整协变量后,干预措施与房颤在首次发作后30天内返回急诊室的比率小幅增加有关(1.6%至2.7%;危险比,1.70[95%CI,1.26-2.31];结论:我们证明,实施一种新的决策辅助工具来指导患者的处置,ED对房颤的初步诊断与入院率的降低有关,这与患者和医院因素无关。该方案的使用与30天随访时AF重复出现率的小幅但显著增加有关。使用如本文所述的决策辅助工具是减少不必要的房颤住院的重要工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implementation of an Atrial Fibrillation Decision Aid Care Pathway in the Emergency Department Reduces Atrial Fibrillation Hospitalizations.

Background: A straightforward decision aid to guide disposition of atrial fibrillation (AF) patients in the emergency department (ED) was developed for use by ED providers. The implementation of this decision aid in the ED has not been studied.

Methods: A pragmatic stepped-wedge cluster approach for analysis of retrospectively collected electronic health record data was used in which 5 hospitals were selected to commence the intervention at periodic intervals following an initial 1-year baseline assessment with 5 additional hospitals included in the comparison group (all in North Carolina). The primary end point of analysis was hospitalization rate. Hierarchical multivariable logistic regression analyses for admission as a function of the intervention while controlling for prespecified patient and hospital predictors were performed with clustering done at the hospital level.

Results: Between October 2017 and May 2020, a total of 11 458 patients (mean age, 71.4; 50.5% female) presented to 1 of the 10 hospitals with a primary diagnosis of AF. Absolute admission rate was reduced from 60.5% to 48.3% following the intervention (odds ratio, 0.83 [95% CI, 0.71-0.97]; P=0.016). After adjusting for covariates, the intervention was associated with a small increased rate of return to the ED for AF within 30 days of the initial presentation (1.6% to 2.7%; hazard ratio, 1.70 [95% CI, 1.26-2.31]; P<0.001).

Conclusions: We demonstrate that implementation of a novel decision aid to guide disposition of patients primary diagnosis of AF presenting to the ED was associated with a reduced admission rate independent of patient and hospital factors. Use of the protocol was associated with a small but significant increase in rate of repeat presentations for AF at 30-day follow-up. Use of a decision aid such as the one described here represents an important tool to reduce unnecessary AF hospitalizations.

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来源期刊
Circulation. Cardiovascular Quality and Outcomes
Circulation. Cardiovascular Quality and Outcomes Medicine-Cardiology and Cardiovascular Medicine
CiteScore
9.80
自引率
2.90%
发文量
357
期刊介绍: Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
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