Role of in-hospital care quality in reducing anxiety and readmissions of kidney transplant recipients
Role of in-hospital care quality in reducing anxiety and readmissions of kidney transplant recipients
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DOI：
10.1016/j.jss.2016.05.032
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发表时间：
2016-09-01
影响因子：
2.2
通讯作者：
Moffatt-Bruce, Susan
中科院分区：
文献类型：
--
作者：
Chandrasekaran, Aravind;Anand, Gopesh;Moffatt-Bruce, Susan
背景：在美国，每年共有17,000名患者接受肾脏移植。肾移植受者30天再住院率超过30%。我们的研究重点是肾移植患者住院期间提供的护理质量与患者的健康结局和与移植相关的再入院之间的关系。方法：我们在美国一家主要的移植中心采访了20名肾移植受者。这些访谈的结果被用来为使用结构化调查收集数据提供信息，这些调查被应用于另外77名肾移植患者。我们使用普通最小二乘回归来预测住院护理质量的两个维度-信息一致性和同理心护理提供-对出院后1周患者焦虑水平的影响。结果：出院后1wk的患者焦虑水平与信息一致性和同理心提供的护理服务显著相关。出院后1周的患者焦虑与30天再入院的发生有关。Logistic回归模型表明，出院后1wk患者焦虑水平每增加一个单位，再次入院的风险就高出110%。最后，患者焦虑在信息一致性和同理心传递对30d再入院的影响中起完全中介作用(50.96%的影响是中介的)。结论：我们的研究提出了两种通过降低出院后焦虑来预防再入院的方法：(1)规范住院护理，使患者所接受的信息保持一致；(2)通过培训护理者在传递信息的过程中对患者更具同理心。(C)2016 Elsevier Inc.保留所有权利。
Background: A total of 17,000 patients receive kidney transplants each year in the United States. The 30-day readmission rate for kidney transplant recipients is over 30%. Our research focuses on the relationship between the quality of care delivered during the patient's hospital stay for a kidney transplant, and the patient health outcomes and readmissions related to the transplant.Methods: We interviewed 20 kidney transplant recipients at a major transplant center in the United States. Findings from these interviews were used to inform the data collection using structured surveys, which were administered to an additional 77 kidney transplant recipients. We used ordinary least squares regression to predict the effects of two dimensions of in-hospital care quality-information consistency and empathetic care delivery-on level of patient anxiety 1 week following discharge. Further, we estimated a logistic regression to predict the effect of anxiety, combined with the two dimensions of in-hospital care quality, on occurrence of 30-day readmissions.Results: Patient anxiety levels 1 wk after discharge are significantly associated with information consistency and empathetic delivery of care. Patient anxiety 1 wk after discharge is associated with occurrence of 30-d readmissions. The logistic regression model indicates that the risk of getting readmitted is 110% higher for a one unit increase in patient anxiety level 1 wk after discharge. Finally, patient anxiety fully mediates the effects of consistency of information and empathetic care delivery on occurrence of 30-d readmissions (50.96% of the effect is mediated).Conclusions: Our study suggests two ways of preventing readmissions through reduction of postdischarge anxiety: (1) standardizing in-hospital care, so that information received by patients is consistent, and (2) by training caregivers to be more empathetic toward patients during the delivery of this information. (C) 2016 Elsevier Inc. All rights reserved.