The relationship between in-hospital location and outcomes of care in patients diagnosed with dementia and/or delirium diagnoses: analysis of patient journey.
The relationship between in-hospital location and outcomes of care in patients diagnosed with dementia and/or delirium diagnoses: analysis of patient journey.
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DOI：
10.1186/s12877-016-0372-5
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发表时间：
2016-11-24
期刊：
影响因子：
4.1
通讯作者：
Crotty M
中科院分区：
文献类型：
--
作者：
Perimal-Lewis L;Bradley C;Hakendorf PH;Whitehead C;Heuzenroeder L;Crotty M
入院人数和病床分配之间的差异意味着许多入院的患者可能会被安置在专门治疗患者主要健康问题的病房或病房（家庭病房）之外。这些患者被称为“异常”患者。诊断为痴呆和/或谵妄的“异常”患者的医院护理的危险因素和卫生系统结果尚不清楚。因此，本研究的目的是检查痴呆症和/或谵妄诊断患者的患者旅程，以确定“正常”或“异常”状态的风险因素以及该状态的患者或卫生系统结果（后果）。一项回顾性描述性研究根据在家庭病房度过的时间比例（即“正常值”或“异常值”）对患有痴呆症和/或谵妄的患者进行了比较。提取并分析了南澳大利亚公立医院弗林德斯医疗中心 (FMC) 2007 年至 2014 年患者旅程数据库的数据。该分析是对患有痴呆症和/或谵妄症的患者的患者旅程进行的。当对 FMC 内 6367 名患有痴呆和/或谵妄的患者住院旅程进行检查时，与“正常”患者相比，“异常”患者入院后急诊科 (ED) 住院时间 (LOS) 延长（OR：1.068，95% CI：1.057–1.079，p = 0.000）。然而，“异常”患者的住院 LOS 仅略短于“正常”患者（OR：0.998，95% CI：0.998–0.998，p = 0.000）。 “异常”患者入院 48 小时内死亡的几率增加（OR：1.973，95% CI：1.158–3.359，p = 0.012），并且他们的查尔森共病指数更高（OR：1.059，95% CI：1.021–1.10， p = 0.002)。 “异常”患者出院后 2 天内完成出院总结受到影响（OR：1.754，95% CI：1.492–2.061，p = 0.000）。此外，“异常”患者更有可能出院到另一家医院接受 FMC 不提供的其他护理类型（OR：1.931，95% CI： 1.559–2.391，p = 0.000）。对 FMC 患者旅程的检查确定，尽管研究人群具有同质性，但在家庭病房外收治的痴呆症和/或谵妄患者的医疗系统结果仍会受到院内地点的影响。
The discrepancy between the number of admissions and the allocation of hospital beds means that many patients admitted to hospital can be placed in units or wards other than that which specialise in the patient’s primary health issue (home-ward). These patients are called ‘outlier’ patients. Risk factors and health system outcomes of hospital care for ‘outlier’ patients diagnosed with dementia and/or delirium are unknown. Therefore, the aim of this research was to examine patient journeys of people with dementia and/or delirium diagnoses, to identify risk factors for ‘inlier’ or ‘outlier’ status and patient or health system outcomes (consequences) of this status. A retrospective, descriptive study compared patients who had dementia and/or delirium according to the proportion of time spent on the home ward i.e. ‘inliers’ or ‘outliers’. Data from the patient journey database at Flinders Medical Centre (FMC), a public hospital in South Australia from 2007 and 2014 were extracted and analysed. The analysis was carried out on the patient journeys of people with a dementia and/or delirium diagnosis. When 6367 inpatient journeys with dementia and/or delirium within FMC were examined, the Emergency Department (ED) Length of Stay (LOS) after being admitted as inpatient was prolonged for ‘outlier’ patients compared to ‘inlier’ patients (OR: 1.068, 95% CI: 1.057–1.079, p = 0.000). However, the inpatient LOS for’outlier’ patients was only marginally shorter than that of the ‘inlier’ patients (OR: 0.998, 95% CI: 0.998–0.998, p = 0.000). The chances of dying within 48 h of admission increased for ‘outlier’ patients (OR: 1.973, 95% CI: 1.158–3.359, p = 0.012) and their Charlson co-morbidity Index was higher (OR: 1.059, 95% CI: 1.021–1.10, p = 0.002). Completion of discharge summaries within 2 days post-discharge for ‘outlier’ patients was compromised (OR: 1.754, 95% CI: 1.492–2.061, p = 0.000).Additionally, ‘outlier’ patients were more likely to be discharged to another hospital for other care types not offered at FMC (OR: 1.931, 95% CI: 1.559–2.391, p = 0.000). An examination of the patient journeys at FMC has determined that the health system outcomes for patients with dementia and/or delirium who are admitted outside of their home-ward are affected by in-hospital location despite the homogenous nature of the study population.
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影响因子：
2.1
作者：
LoGiudice, D.;Watson, R.
通讯作者：
Watson, R.
影响因子：
3.1
作者：
Brick, Craig;Lowes, Justin;Rowe, Brian H.
通讯作者：
Rowe, Brian H.
DOI：
10.1111/j.1365-2753.2011.01772.x
发表时间：
2013-02-01
影响因子：
2.4
作者：
Li, Jordan Y. Z.;Yong, Tuck Y.;Thompson, Campbell H.
通讯作者：
Thompson, Campbell H.
影响因子：
4.1
作者：
Korevaar JC;van Munster BC;de Rooij SE
通讯作者：
de Rooij SE
影响因子：
120.7
作者：
Phelan, Elizabeth A.;Borson, Soo;Grothaus, Louis;Balch, Steven;Larson, Eric B.
通讯作者：
Larson, Eric B.