Capturing Emergency Department Discharge Quality With the Care Transitions Measure: A Pilot Study
Capturing Emergency Department Discharge Quality With the Care Transitions Measure: A Pilot Study
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DOI：
10.1111/acem.13623
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发表时间：
2019-06-01
影响因子：
4.4
通讯作者：
Gallagher, Thomas H.
中科院分区：
文献类型：
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作者：
Sabbatini, Amber K.;Gallahue, Fiona;Gallagher, Thomas H.
背景最近的注意力已被给予发展的措施，以捕捉质量的艾德过渡的照顾。我们研究了患者报告的过渡性护理措施，护理过渡措施-3（CTM-3），在艾德设置及其与艾德出院后的护理结果的关联的效用。方法对一个学术卫生系统的两个急诊科（ED）出院后14天的方便样本患者进行电话调查。患者使用四点一致性量表对三个陈述做出回应（非常不同意，不同意，同意，非常同意）：1）“医院工作人员在决定我的医疗保健需求时考虑了我和我的家人或护理者的偏好”; 2）“当我离开急诊室时，我很好地理解了我在管理我的健康方面所负责的事情”; 3）“当我离开医院时，我清楚地了解了服用每种药物的目的。“患者还被询问了艾德出院后的结果，这些结果已知与艾德护理过渡有关，包括药物依从性，完成推荐的随访，以及对ED的回访。多变量logistic回归用于确定CTM-3评分（100分制）与感兴趣的结果之间的关联。结果在1,832名患者中，576人通过电话联系，410人同意并完成了我们的调查，占我们试图致电的患者的22.4%。CTM-3评分增加10分（更好的护理体验）与艾德回访的几率降低12%相关（调整后的比值比[AOR] = 0.88，95%置信区间[CI] = 0.77-1.00），按建议服用处方药的几率增加45%（AOR = 1.45，95%CI = 1.12-1.87）。CTM-3评分与完成随访之间无相关性。结论CTM-3与艾德访视后的护理结局相关，包括艾德回访和药物依从性，并可作为患者报告的艾德护理过渡措施。
Background Recent attention has been given to developing measures to capture the quality of ED transitions of care. We examined the utility of a patient-reported measure of transitional care, the Care Transitions Measure-3 (CTM-3), in the ED setting and its association with outcomes of care after ED discharge. Methods A telephone survey was conducted of a convenience sample of patients 14 days after discharge from two emergency departments (EDs) in an academic health system. Patients responded to three statements using a four-point agreement scale (strongly disagree, disagree, agree, strongly agree): 1) "The hospital staff took my preferences and those of my family or caregiver into account when deciding what my health care needs would be"; 2) " When I left the ER, I had a good understanding of the things I was responsible for in managing my health"; and 3) "When I left the hospital, I clearly understood the purpose for taking each of my medications." Patients were also queried about outcomes after ED discharge that are known to be related to ED care transitions including medication adherence, completion of recommended follow-up, and return visits to the ED. Multivariable logistic regression was used to determine the association between the CTM-3 score (on a 100-point scale) and outcomes of interest. Results Among 1,832 patients called, 576 were reached by phone, and 410 consented and completed our survey, representing a 22.4% response rate of patients we attempted to call. A 10-point increase in the CTM-3 score (better care experiences) was associated with a 12% decrease in the odds of having an ED return visit (adjusted odds ratio [AOR] = 0.88, 95% confidence interval [CI] = 0.77-1.00) and a 45% increase in the odds of taking prescribed medications as recommended (AOR = 1.45, 95% CI = 1.12-1.87). There was no association between CTM-3 score and completion of follow-up. Conclusions The CTM-3 is associated with outcomes of care after an ED visit, including ED return visits and medication adherence, and may have utility as a patient-reported measure of ED transitions of care.