The association between patient experience factors and likelihood of 30-day readmission: a prospective cohort study
The association between patient experience factors and likelihood of 30-day readmission: a prospective cohort study
复制标题
DOI：
10.1136/bmjqs-2017-007184
复制
发表时间：
2018-09-01
影响因子：
5.4
通讯作者：
Donelan, Karen
中科院分区：
文献类型：
--
作者：
Carter, Jocelyn;Ward, Charlotte;Donelan, Karen
医院护理占美国医疗保健支出的近三分之一。据认为，这些支出中有15%至20%是可以预防的。风险预测模型具有次优的准确性，并且通常排除患者经验数据。没有研究探讨患者在索引入院期间对再入院可能性的看法。我们的目的是检查患者在索引医院入院和30天再入院期间对护理的感知之间的关联。设计前瞻性队列研究。设置马萨诸塞州波士顿总医院的两个住院成人医学单位，马萨诸塞州。参与者840人-在2012年1月至2016年1月期间，有6名患者入住研究单位，他们符合资格标准并同意入组。结果在1754例符合条件的受试者中，846例（48%）入组，201例（23.8%）在30天内再次入院。再次入院的参与者不太可能拥有高中文凭/GED（44.3%未再次入院vs 53.5%再次入院，P=0.02）。在校正基线差异的多变量模型中，报告对索引住院期间接受的护理“非常满意”的受访者再次入院的可能性较小（校正OR 0.61，95%CI 0.43至0.88，P=0.007）。报告医生“总是仔细倾听”的参与者不太可能再次入院（调整后OR 0.68，95%CI 0.48至0.97，P=0.03）。参与者报告说，他们是“很可能”被重新入院的可能性不大（调整OR 1.35，95%CI 0.83至2.19，P=0.22）。结论参与者报告满意度高，良好的供应商沟通不太可能被重新入院。参与者的再入院率增加，他们说他们很可能被重新入院，尽管这种关联没有统计学意义。在索引住院期间，简化患者报告的指标可能会改善再入院预测。
Objective Hospital care comprises nearly a third of US healthcare expenditures. Fifteen to 20 per cent of this spending is considered to be potentially preventable. Risk prediction models have suboptimal accuracy and typically exclude patient experience data. No studies have explored patient perceptions of the likelihood of readmission during index admission. Our objective was to examine associations between patient perceptions of care during index hospital admission and 30-day readmission.Design Prospective cohort study.Setting Two inpatient adult medicine units at Massachusetts General Hospital Boston, Massachusetts.Participants Eight hundred and forty-six patients admitted to study units between January 2012 and January 2016 who met eligibility criteria and consented to enrolment.Main outcome Odds of 30-day readmission.Results Of 1754 eligible participants, 846 (48%) were enrolled and 201 (23.8%) were readmitted within 30 days. Readmitted participants were less likely to have a high school diploma/GED (44.3% not readmitted vs 53.5% readmitted, P=0.02). In multivariable models adjusting for baseline differences, respondents who reported being 'very satisfied' with the care received during the index hospitalisation were less likely to be readmitted (adjusted OR 0.61, 95% CI 0.43 to 0.88, P=0.007). Participants reporting doctors 'always listened to them carefully' were less likely to be readmitted (adjusted OR 0.68, 95% CI 0.48 to 0.97, P=0.03). Participants reporting they were 'very likely' to be readmitted were not more likely to be readmitted (adjusted OR 1.35, 95% CI 0.83 to 2.19, P=0.22).Conclusion Participants reporting high satisfaction and good provider communication were less likely to be readmitted. Rates of readmission were increased among participants stating they were very likely to be readmitted though this association was not statistically significant. Incorporating patient-reported measures during index hospitalisations may improve readmission prediction.