Discharge intervention pilot improves satisfaction for patients and professionals
Discharge intervention pilot improves satisfaction for patients and professionals
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DOI：
10.1016/j.ejim.2013.08.703
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发表时间：
2013-12-01
影响因子：
8
通讯作者：
Beer, Juerg H.
中科院分区：
文献类型：
--
作者：
Lindpaintner, Lyn S.;Gasser, Juerg Th;Beer, Juerg H.
背景：对于脆弱的多病患者，出院后不良事件和信息丢失的风险特别高。出院时护理协调不佳增加了患者、护理人员和专业人员的负担，并可能导致发病率和费用增加。有针对性的计划，可以提高效率和健康的结果，但理想的组织出院仍然是specification.Methods：这单盲，随机，控制跨专业试点两个内科病房在教学医院在瑞士巴登测试出院管理干预护士护理经理。患者（n = 60）处于不良事件的高风险中，符合标准，如多种药物治疗，抗凝剂或胰岛素治疗，以及表明脆弱性的次要标准。主要复合终点由以下任一项实现：死亡、再次住院、出院后5天内的紧急医生访视或药物不良反应。次要终点评价患者的生活质量，照顾者负担，提供给初级保健医生和家庭护理护士的信息的充分性，以及所有组的出院满意度。通过出院后第5天和第30天的电话访谈进行终点评价。设计进行了严格的评估，预期一个更大的trial.Results：干预接受度高。在干预组中，患者（p = 0.027）和护理人员（p = 0.008）的满意度较高，初级保健医生对出院信息的评价较高（p = 0.031）。主要终点显示组间无显著差异。必要的设计修改被identified.Conclusion：出院协调和后续护理护理的护理管理者显着改善主观终点。计划采用改良设计，以在把握度良好的研究中检验有效性。(C)2013年欧洲内科联合会。Elsevier B.V.出版，保留所有权利。
Background: The risk of adverse events and information loss following hospital discharge is particularly high for vulnerable multimorbid patients. Poor coordination of care at discharge increases the burden upon patients, caregivers and professionals, and can lead to increased morbidity and costs. Targeted programs can improve efficiency and health outcomes, but the ideal organization of hospital discharge remains to be specified.Methods: This single-blind, randomized, controlled interprofessional pilot on two internal medicine wards in a teaching hospital in Baden, Switzerland tested a discharge management intervention using nurse care managers. Patients (n = 60) were at high risk for adverse events, fulfilling criteria such as polypharmacy, therapy with anticoagulants or insulin, plus secondary criteria indicating vulnerability. Primary composite endpoint was fulfilled by any of the following: death, rehospitalization, urgent physician visit within five days of discharge or adverse medicine reaction. Secondary endpoints evaluated patient quality-of-life, caregiver burden, adequacy of information provided to primary care physicians and home care nurses, and satisfaction with discharge for all groups. Endpoint evaluation was via telephone interviews on days 5 and 30 post-discharge. Design was critically evaluated in anticipation of a larger trial.Results: Intervention acceptance was high. In the intervention group, satisfaction was higher among patients (p = 0.027) and caregivers (p = 0.008), and primary care physicians rated discharge information higher (p = 0.031). Primary endpoint showed no significant difference between groups. Necessary design modifications were identified.Conclusion: Discharge coordination and follow-up care by nurse care managers significantly improved subjective endpoints. A modified design is planned to test effectiveness in a well-powered study. (C) 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.