Older Patients' Understanding of Emergency Department Discharge Information and Its Relationship With Adverse Outcomes
Older Patients' Understanding of Emergency Department Discharge Information and Its Relationship With Adverse Outcomes
复制标题
DOI：
10.1097/pts.0b013e31820c7678
复制
发表时间：
2011-03-01
影响因子：
2.2
通讯作者：
Schmader, Kenneth E.
中科院分区：
文献类型：
--
作者：
Hastings, Susan N.;Barrett, Amanda;Schmader, Kenneth E.
目的：了解老年患者对急诊科（ED）出院信息的了解情况，探讨对急诊科出院信息的了解与不良结局的关系。方法：对从学术医疗中心急诊科出院72小时内的65岁及以上患者（或其代理人）进行电话访谈。我们评估了出院信息的4个方面：急诊科诊断、预期病程、自我保健指导和返回注意事项。不良事件定义为急诊出院后90天内重复就诊、住院或死亡。构建反向Kaplan-Meier曲线，根据患者对出院信息的理解来说明累积事件概率（用log-rank检验检验差异）。结果：92名受访患者（平均年龄75.1岁，SD 7.4岁，女性59.8%）中，患者或其代理人表示不了解出院诊断信息（20.7%）、自我护理指导（16.3%）、预期病程（63%）和返回预防措施（55.7%）。出院后90天内，42.3%的患者返回急诊科，30.4%的患者住院，4.3%的患者死亡。根据患者是否理解自我护理指示或返回预防措施，累积事件概率差异不大。不了解ED诊断的患者（P = 0.33）和不了解预期病程的患者（P = 0.12）的不良事件发生率较高，但没有达到统计学意义。结论：大量老年患者或其代理人可能不了解急诊科出院信息，这可能会影响患者的预后。我们需要采取策略来改善老年患者及其家属对急诊科出院信息的沟通。
Objectives: To describe older patients' understanding of emergency department (ED) discharge information and to explore the relationship between understanding of ED discharge information and adverse outcomes.Methods: Telephone interviews were conducted with patients 65 years or older (or their proxies) within 72 hours of discharge from an academic medical center ED. We assessed 4 areas of discharge information: ED diagnosis, expected course of illness, self-care instructions, and return precautions. Adverse events were defined as repeat ED visits and hospitalizations or deaths within 90 days of ED discharge. Reverse Kaplan-Meier curves were constructed to illustrate cumulative event probabilities according to patient understanding of discharge information (differences examined with log-rank tests).Results: Of 92 respondents (mean patient age, 75.1; SD, 7.4; 59.8% female subjects), patients or proxies reported not understanding discharge information about diagnosis (20.7%), self-care instructions (16.3%), expected course of illness (63%), and return precautions (55.7%). Within 90 days of ED discharge, 42.3% of patients had returned to the ED, 30.4% were hospitalized, and 4.3% had died. There was little difference in cumulative event probabilities according to whether patients understood self-care instructions or return precautions. Adverse event probabilities were higher among patients who did not understand their ED diagnosis (P = 0.33) and those who did not understand expected course of illness (P = 0.12), although these did not achieve statistical significance.Conclusions: A substantial number of older patients, or proxies, may not understand ED discharge information, and this could have an effect on patient outcomes. Strategies are needed to improve communication of ED discharge information to older patients and their families.