A reengineered hospital discharge program to decrease rehospitalization: a randomized trial.
A reengineered hospital discharge program to decrease rehospitalization: a randomized trial.
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DOI：
10.7326/0003-4819-150-3-200902030-00007
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发表时间：
2009-02-03
影响因子：
39.2
通讯作者：
Culpepper L
中科院分区：
文献类型：
--
作者：
Jack BW;Chetty VK;Anthony D;Greenwald JL;Sanchez GM;Johnson AE;Forsythe SR;O'Donnell JK;Paasche-Orlow MK;Manasseh C;Martin S;Culpepper L
出院后，急诊科就诊和再次住院是很常见的。测试旨在将出院后医院利用率降至最低的干预措施的效果。采用6和8区组随机化的随机试验。随机排列的索引卡被放置在连续标有研究编号的不透明信封中，参与者通过展示索引卡被分配到一个研究组。城市、学术、安全网医院的综合医疗服务。749名讲英语的住院成年人(平均年龄49.9岁)。一位护士出院倡导者在患者住院期间与他们合作，安排后续预约，确认药物调节，并通过发送给他们的初级保健提供者的个性化说明手册进行患者教育。一名临床药剂师在出院后2至4天致电患者，以加强出院计划并审查药物。参与者和提供者对治疗分配没有视而不见。主要结果是出院后30天内急诊科就诊和住院。次要结果是自我报告的出院准备情况和初级保健提供者在出院后30天内随访的频率。进行跟踪调查的研究人员被蒙在鼓里研究小组任务。干预组(n=370)的医院利用率低于常规护理组(n=368)(每人每月就诊0.314次比0.451次；发生率比0.695[95%CI，0.515~0.937]；P=0.009)。在指数入院前6个月内利用医院的参与者中，干预效果最好(P=0.014)。没有对不良事件进行评估；这些数据已经收集，但仍在分析中。这是一项单中心研究，并不是所有可能符合条件的患者都可以入选，结果评估有时依赖于参与者的报告。一系列出院服务减少了出院后30天内的医院使用率。
Emergency department visits and rehospitalization are common after hospital discharge. To test the effects of an intervention designed to minimize hospital utilization after discharge. Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card. General medical service at an urban, academic, safety-net hospital. 749 English-speaking hospitalized adults (mean age, 49.9 years). A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment. Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers′ follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment. Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed. This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report. A package of discharge services reduced hospital utilization within 30 days of discharge.
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DOI：
10.1016/0197-2456(88)90049-9
发表时间：
1988-12-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
LACHIN, JM;MATTS, JP;WEI, LJ
通讯作者：
WEI, LJ
影响因子：
105.7
作者：
Holland, R;Lenaghan, E;Hand, C
通讯作者：
Hand, C
影响因子：
2.5
作者：
Friedman, B;Basu, J
通讯作者：
Basu, J
影响因子：
--
作者：
Moore, Carlton;McGinn, Thomas;Halm, Ethan
通讯作者：
Halm, Ethan
影响因子：
39.2
作者：
NAYLOR, M;BROOTEN, D;PAULY, M
通讯作者：
PAULY, M