Care delivery team composition effect on hospitalization risk in African Americans with congestive heart failure.
Care delivery team composition effect on hospitalization risk in African Americans with congestive heart failure.
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DOI：
10.1371/journal.pone.0286363
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
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护理服务团队 (CDT) 对于为受充血性心力衰竭 (CHF) 影响尤为严重的患者提供护理机会和公平性至关重要。然而，与护理结果相关的具体临床作用尚不清楚。本研究的目的是探讨 CDT 中的特定临床作用与患有 CHF 的非裔美国人 (AA) 护理结果的相关程度。收集了 5,962 名患者的去识别化电子病历数据，代表 2014 年 1 月 1 日至 2021 年 12 月 31 日期间 3,284 名临床医生的 80,921 次护理经历。二项式 Logistic 回归评估了特定临床角色的关联，Mann Whitney-U 评估了结果中的种族差异。 AA 仅占研究人群的 26%，但产生了总护理经历的 48%，与最大种族群体（即白人美国人；占研究人口的 69%）产生的护理经历的比例相同。 AA 的住院和再入院人数明显高于白人美国人。然而，与白人美国人相比，AA 人在家的天数明显更高，护理费用也明显更低。在所有 CHF 患者中，在 7 年研究期间，有注册护士进行 CDT 的患者住院治疗的可能性较小（即 30%），而再入院的可能性较高（即 31%）。按心力衰竭表型分层时，有注册护士进行 CDT 的最严重患者住院的可能性降低了 88%，再次入院率较高的可能性降低了 50%。在不太严重的心力衰竭病例中也发现了类似的住院和再入院可能性的降低。特定的临床作用与慢性心力衰竭的护理结果相关。必须考虑开发和测试更专业的 CDT 成分经验模型的功效，以减少 CHF 的不成比例的影响。
The care delivery team (CDT) is critical to providing care access and equity to patients who are disproportionately impacted by congestive heart failure (CHF). However, the specific clinical roles that are associated with care outcomes are unknown. The objective of this study was to examine the extent to which specific clinical roles within CDTs were associated with care outcomes in African Americans (AA) with CHF. Deidentified electronic medical record data were collected on 5,962 patients, representing 80,921 care encounters with 3,284 clinicians between January 1, 2014 and December 31, 2021. Binomial logistic regression assessed associations of specific clinical roles and the Mann Whitney-U assessed racial differences in outcomes. AAs accounted for only 26% of the study population but generated 48% of total care encounters, the same percentage of care encounters generated by the largest racial group (i.e., Caucasian Americans; 69% of the study population). AAs had a significantly higher number of hospitalizations and readmissions than Caucasian Americans. However, AAs had a significantly higher number of days at home and significantly lower care charges than Caucasian Americans. Among all CHF patients, patients with a Registered Nurse on their CDT were less likely to have a hospitalization (i.e. 30%) and a high number of readmissions (i.e., 31%) during the 7-year study period. When stratified by heart failure phenotype, the most severe patients who had a Registered Nurse on their CDT were 88% less likely to have a hospitalization and 50% less likely to have a high number of readmissions. Similar decreases in the likelihood of hospitalization and readmission were also found in less severe cases of heart failure. Specific clinical roles are associated with CHF care outcomes. Consideration must be given to developing and testing the efficacy of more specialized, empirical models of CDT composition to reduce the disproportionate impact of CHF.
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