Does increased access to primary care reduce hospital readmissions?
Does increased access to primary care reduce hospital readmissions?
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DOI：
10.1056/nejm199605303342206
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发表时间：
1996-05-30
影响因子：
158.5
通讯作者：
Henderson, WG
中科院分区：
文献类型：
--
作者：
Weinberger, M;Oddone, EZ;Henderson, WG
背景对于慢性病患者，再入院可能是频繁和昂贵的。我们研究了旨在增加出院后获得初级保健的干预措施的效果，其目标是减少再入院和急诊室就诊，提高患者的生活质量和对护理的满意度。在9个退伍军人事务医疗中心进行的一项多中心随机对照试验中，我们将1396名因糖尿病、慢性阻塞性肺病或充血性心力衰竭住院的退伍军人随机分为两组，一组接受常规护理，另一组接受强化初级护理干预。干预包括由一名护士和一名初级护理医生进行密切随访，从出院前开始，持续6个月。这些病人病情严重，半数患有充血性心力衰竭（504名患者）患有纽约心脏协会III或IV级疾病; 30%的糖尿病患者终末器官损害751例;四分之一的慢性阻塞性肺病患者（583名患者）需要家庭氧气治疗或口服皮质类固醇，这些患者的生活质量评分极差，尽管他们接受了比对照组更多的强化初级护理，干预组再入院率（每月0.19比0.14，P = 0.005）和再住院天数（每月10.2比8.8，P = 0.041）明显高于对照组（P
Background. For chronically ill patients, readmission to the hospital can be frequent and costly, We studied the effect of an intervention designed to increase access to primary care after discharge from the hospital, with the goals of reducing readmissions and emergency department visits and increasing patients' quality of life and satisfaction with care.Methods. In a multicenter randomized, controlled trial at nine Veterans Affairs Medical Centers, we randomly assigned 1396 veterans hospitalized with diabetes, chronic obstructive pulmonary disease, or congestive heart failure to receive either usual care or an intensive primary care intervention, The intervention involved close follow-up by a nurse and a primary care physician, beginning before discharge and continuing for the next six months.Results. The patients were severely ill, Half of those with congestive heart failure (504 patients) had disease in New York Heart Association class III or IV; 30 percent of those with diabetes (751 patients) had end-organ damage; and a quarter of those with chronic obstructive pulmonary disease (583 patients) required home oxygen treatment or oral corticosteroids, The patients had extremely poor quality-of-life scores, Although they received more intensive primary care than the controls, the patients in the intervention group had significantly higher rates of readmission (0.19 vs, 0.14 per month, P=0.005) and more days of rehospitalization (10.2 vs, 8.8, P=0.041), The patients in the intervention group were more satisfied with their care (P