Home Healthcare Nursing Visits for Nonhomebound Patients With Heart Failure After Hospital Discharge: A Quality-Improvement Pilot Project.
Home Healthcare Nursing Visits for Nonhomebound Patients With Heart Failure After Hospital Discharge: A Quality-Improvement Pilot Project.
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DOI：
10.1097/nhh.0000000000000925
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发表时间：
2021-01-01
影响因子：
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通讯作者：
Stehlik, Josef
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文献类型：
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作者：
Kang, Youjeong;Mondesir, Favel L;Young, Dawn;Norris, Eddie;Hernandez, Juan M;Nativi-Nicolau, Jose;Stehlik, Josef
心衰（HF）患者频繁再住院导致患者负担和费用增加。住家的HF患者出院后有资格享受家庭保健。非足不出户的心衰患者是否也可以从家庭保健护理（HHN）访问中获益，以改善从医院到家庭的过渡，目前尚未得到验证。我们的质量改进试点研究的目的是评估出院后门诊患者HHN就诊对30天再住院率的影响。我们纳入了因非居家状态而在出院时不适合家庭保健服务的心衰患者。家庭护理护士遵循美国心脏协会的《超越心力衰竭》材料中修改过的出院清单。家庭护理护士根据患者的反应提供适当的教育。我们在研究中招募了68名患者。平均年龄60岁；61%为男性，80%为白人。根据患者对检查表的反应，HHN访视期间解决的关键领域是药物管理、自我保健和对HF行为的遵守。研究患者的30天再住院率为15%，而540名符合纳入标准但未纳入研究的患者在相同时间内出院，再住院率为23% （p = .12）。我们的试点数据表明，hhn在门诊患者中是可行的，并且在数字上降低了出院后30天的再住院率。该方法的临床疗效有待进一步研究证实。
Frequent rehospitalizations among patients with heart failure (HF) result in patient burden and cost. Homebound patients with HF qualify for home healthcare after hospital discharge. Whether nonhomebound ambulatory patients with HF could also benefit from home healthcare nursing (HHN) visits to improve the transition from hospital to home has not been tested. The purpose of our quality-improvement pilot study was to assess the impact of HHN visits provided to ambulatory patients after hospital discharge on the 30-day rehospitalization rate. We included patients with HF ineligible for home healthcare services at hospital discharge due to their nonhomebound status. Home healthcare nurses followed a modified version of the Discharge Checklist from the American Heart Association’s Rise Above Heart Failure materials. Home healthcare nurses provided education as appropriate based on patients’ responses. We enrolled 68 patients in the study. The mean age was 60 years; 61% were male and 80% were White. Based on patient responses to the Checklist, key areas addressed during HHN visits were medication management, self-care, and adherence to HF behaviors. The 30-day rehospitalization rate of the study patients was 15%, compared with 23% among 540 patients discharged in the same time frame who met the inclusion criteria but were not enrolled in the study (p = .12). Our pilot data show that HHNs in ambulatory patients are feasible and result in a numerically lower 30-day rehospitalization rate after discharge. Further study is needed to confirm the clinical efficacy of this approach.