The Complexity of Determining Whether a Nursing Home Transfer Is Avoidable at Time of Transfer
The Complexity of Determining Whether a Nursing Home Transfer Is Avoidable at Time of Transfer
复制标题
DOI：
10.1111/jgs.15286
复制
发表时间：
2018-05-01
影响因子：
6.3
通讯作者：
Arling, Greg
中科院分区：
文献类型：
--
作者：
Unroe, Kathleen T.;Carnahan, Jennifer L.;Arling, Greg
目的：描述急性转移时护理机构居民风险条件和体征和症状之间的关系，以及与潜在可避免的急性转移（肺炎、尿路感染、充血性心力衰竭（CHF）、慢性阻塞性肺疾病（COPD）或哮喘、脱水、压疮）相关的条件的诊断。设计：作为减少可能避免的医院转院的示范项目的一部分，优化患者转院，影响医疗质量，改善症状：转变机构护理（乐观）项目临床工作人员收集了转到急诊科（ED）或医院的居民的数据。交叉表用于确定危险状况或症状与医院诊断或死亡之间的关联。混合效应逻辑回归模型用于描述风险状况、体征或症状作为潜在可避免的医院诊断或死亡预测因子的重要性。地点：印第安纳州护理机构（N=19）。参与者：长期护理机构的居民（N= 1174），从2014年11月到2016年7月经历了1931次急性转移。测量：参与者症状、转移、危险因素和医院诊断。结果：我们发现44%的急性转移与6种潜在可避免诊断中的1种相关。转院前的症状在医院诊断中没有很好的区别。症状映射到多个诊断，大多数医院诊断有多个相关症状。例如，超过三分之二的有慢性心力衰竭和慢性阻塞性肺病病史的居民的急性转移是由于这两种疾病的恶化以外的原因。结论：虽然人们普遍认为许多护理机构居民的转移是可以避免的，但在转移时确定可避免性是复杂的。症状和危险状况对医院诊断只有微弱的预测作用。
OBJECTIVES: To describe the relationship between nursing facility resident risk conditions and signs and symptoms at time of acute transfer and diagnosis of conditions associated with potentially avoidable acute transfers (pneumonia, urinary tract infection, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) or asthma, dehydration, pressure sores).DESIGN: As part of a demonstration project to reduce potentially avoidable hospital transfers, Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project clinical staff collected data on residents who transferred to the emergency department (ED) or hospital. Cross-tabulations were used to identify associations between risk conditions or symptoms and hospital diagnoses or death. Mixed-effects logistic regression models were used to describe the significance of risk conditions, signs, or symptoms as predictors of potentially avoidable hospital diagnoses or death.SETTING: Indiana nursing facilities (N=19).PARTICIPANTS: Long-stay nursing facility residents (N=1,174), who experienced 1,931 acute transfers from November 2014 to July 2016.MEASUREMENTS: Participant symptoms, transfers, risk factors, and hospital diagnoses.RESULTS: We found that 44% of acute transfers were associated with 1 of 6 potentially avoidable diagnoses. Symptoms before transfer did not discriminate well among hospital diagnoses. Symptoms mapped into multiple diagnoses and most hospital diagnoses had multiple associated symptoms. For example, more than two-thirds of acute transfers of residents with a history of CHF and COPD were for reasons other than exacerbations of those two conditions.CONCLUSION: Although it is widely recognized that many transfers of nursing facility residents are potentially avoidable, determining avoidability at time of transfer is complex. Symptoms and risk conditions were only weakly predictive of hospital diagnoses.