Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities
Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities
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DOI：
10.1016/j.jamda.2017.05.021
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发表时间：
2017-10-01
影响因子：
7.6
通讯作者：
Boxer, Rebecca S.
中科院分区：
文献类型：
--
作者：
Lum, Hillary;Obafemi, Oluyomi;Boxer, Rebecca S.
背景资料：住院并入住专业护理机构（SNF）的心力衰竭（HF）患者存在再次住院和死亡的高风险。这一高风险人群的护理偏好尚未研究。目的：描述根据治疗范围医嘱（MOST）文件入住SNF的HF患者的康复护理偏好，并根据MOST文件、急诊科（艾德）就诊和住院情况评估目标一致性护理。设计、设置和参与者：2014年7月至2016年5月期间，对35个SNF中HF患者进行回顾性研究，这些患者参加了一项HF疾病管理与常规护理的随机对照试验。测量：MOST表格的有效性、护理偏好记录和SNF入院后60天内的艾德访视/住院。在370例患者（平均年龄78.6岁，58%为女性，25%为收缩期HF）中，278例（75%）在SNF表中有MOST表，其中96例（35%）无效。MOST表无效的最常见原因是患者或提供者签名所附日期缺失。在182份有效的MOST表格中，47%的患者选择了无心肺复苏（“无CPR”），58%选择了“全面治疗”，17%选择了“选择性治疗”，23%选择了“以舒适为重点的治疗”。“年龄较大的患者[比值比（OR）= 1.50，95%置信区间（CI）= 1.25，1.81]和女性（OR = 2.33，95% CI = 1.18，4.59）选择“无心肺复苏”的几率较高。“182例有效MOST表的患者中有66例（36%）在SNF入院后60天内进行了艾德/医院访视;只有3例患者接受了可能不一致的医疗护理：所有3例患者都选择了“以舒适为中心的治疗”，并住院治疗超过症状管理。75%的HF患者在SNF入院时使用MOST表记录了护理偏好，95%的患者根据SNF入院时记录的护理偏好接受了目标一致的护理。(C)2017年AMDA -急性后和长期护理医学协会。
Background: Individuals with heart failure (HF) who are hospitalized and admitted to skilled nursing facilities (SNFs) are at high risk for rehospitalization and death. The care preferences of this high-risk population have not been studied.Objectives: To describe care preferences of patients with HF admitted to SNFs for rehabilitation based on Medical Orders for Scope of Treatment (MOST) documentation, and evaluate goal-concordant care based on MOST documentation, emergency department (ED) visits, and hospitalization.Design, setting, and participants: Retrospective study of patients with HF in 35 SNFs enrolled in a randomized controlled trial of HF-disease management versus usual care between July 2014 and May 2016.Measurements: Validity of MOST forms, care preference documentation, and ED visits/hospitalizations within 60 days of SNF admission.Results: Of 370 patients (mean age 78.6 years, 58% women, 25% systolic HF), 278 (75%) had a MOST form in the SNF chart, of which 96 forms (35%) were invalid. The most common reason for an invalid MOST form was missing date accompanying patient or provider signature. Of 182 valid MOST forms, 47% of patients chose no cardiopulmonary resuscitation ("No CPR"), 58% selected "Full Treatment," 17% chose "Selective Treatment," and 23% chose "Comfort-Focused Treatment." Patients who were older [odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.25, 1.81] and female (OR = 2.33, 95% CI = 1.18, 4.59) had higher odds of choosing "No CPR." Sixty-six of 182 patients (36%) with valid MOST forms had an ED/hospital visit within 60 days of SNF admission; only 3 patients received medical care that was potentially discordant: all 3 chose "Comfort-Focused Treatment" and were hospitalized for more than symptom management.Conclusion: Seventy-five percent of patients with HF admitted to SNFs had care preferences documented using the MOST form, and 95% received goal-concordant care based on care preferences documented during the SNF admission. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.