Tying up loose ends - Discharging patients with unresolved medical issues
Tying up loose ends - Discharging patients with unresolved medical issues
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DOI：
10.1001/archinte.167.12.1305
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发表时间：
2007-06-25
影响因子：
--
通讯作者：
Halm, Ethan
中科院分区：
文献类型：
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作者：
Moore, Carlton;McGinn, Thomas;Halm, Ethan
背景：越来越多的患者因未解决的医疗问题而出院，需要门诊随访。本研究评估了医院医生推荐门诊检查的频率，以解决患者未解决的医疗问题，以及出院摘要的可用性对检查完成的影响。方法：对2002年6月1日至2003年12月31日从某大型教学医院内科或老年科出院的患者进行回顾性队列研究。每个受试者的住院医疗记录被审查，以确定医院医生是否建议门诊检查。然后审查受试者的门诊医疗记录，以确定检查是否完成。结果：693例出院患者中，191例（27.6%）接受了医院医生推荐的240次门诊检查。检查类型为诊断程序（47.9%）、亚专科转诊（35.4%）和实验室检查（16.7%）。最常见的诊断程序是计算机断层扫描，以跟踪以前的x线检查中发现的异常，内窥镜检查，以跟踪胃肠道出血。在推荐的检查中，35.9%未完成。增加出院后初级保健医生初次就诊的时间降低了完成推荐检查的可能性（优势比，0.77；P= 0.002），而记录推荐检查的出院摘要的可用性增加了完成检查的可能性（优势比，2.35；P= 0.007）。结论：出院后未完成推荐门诊检查是常见的。初级保健医生获得记录推荐检查的出院总结与更好地完成建议相关。未来的研究应侧重于干预措施，以提高出院信息的质量和传播给初级保健医生。
Background: Patients are increasingly being discharged from the hospital with unresolved medical problems requiring outpatient follow-up. This study evaluates the frequency with which hospital physicians recommend outpatient workups to address patients' unresolved medical problems and the impact that availability of discharge summaries has on workup completion.Methods: We conducted a retrospective cohort study of patients discharged from the medicine or geriatrics service of a large teaching hospital between June 1, 2002, and December 31, 2003. Each subject's inpatient medical record was reviewed to determine if the hospital physician recommended an outpatient workup. Subjects' outpatient medical records were then reviewed to determine if the workups were completed.Results: Of 693 hospital discharges, 191 discharged patients (27.6%) had 240 outpatient workups recommended by their hospital physicians. The types of workups were diagnostic procedures (47.9%), subspecialty referrals (35.4%), and laboratory tests (16.7%). The most common diagnostic procedures were computed tomographic scans to follow up abnormalities seen on previous radiographic studies and endoscopic procedures to follow up gastrointestinal tract bleeding. Of recommended workups, 35.9% were not completed. Increasing time to the initial postdischarge primary care physician visit decreased the likelihood that a recommended workup was completed (odds ratio, 0.77; P=.002), and availability of a discharge summary documenting the recommended workup increased the likelihood of workup completion (odds ratio, 2.35; P=.007).Conclusions: Noncompletion of recommended outpatient workups after hospital discharge is common. Primary care physicians' access to discharge summaries documenting the recommended workup is associated with better completion of recommendations. Future research should focus on interventions to improve the quality and dissemination of discharge information to primary care physicians.