Discharge Handoff Communication and Pediatric Readmissions
Discharge Handoff Communication and Pediatric Readmissions
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DOI：
10.1002/jhm.2670
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发表时间：
2017-01-01
影响因子：
2.6
通讯作者：
Chung, Paul J.
中科院分区：
文献类型：
--
作者：
Coller, Ryan J.;Klitzner, Thomas S.;Chung, Paul J.
背景技术背景：尽管对儿童出院后结局的影响尚不清楚，但医院过渡期护理的改善已成为国家的主要优先事项。目的：描述医院和初级保健提供者（PCP）之间常见的交接实践，并检验常见交接实践与较少的计划外再入院相关的假设。这项前瞻性队列研究招募了2012- 2014年在三级儿童医院急性住院期间随机选择的儿科患者。初级保健和病人的数据是从行政，照顾者，PCP的调查问卷，通过30天出院入院。主要结局是30天内计划外再入院。Logistic回归评估再入院和11个交接沟通practices.Results之间的关系：我们招募了701名儿童，其中685个确定的PCP。从84%的PCP中收集了完整的数据。沟通方式差异很大----很少发生口头上的争吵（10.7%）; 50.8%发生PCP入院通知。护理人员的经验得分，采用适应护理过渡措施-3，高，但不相关的再入院。30天的非计划性再入院与大多数移交实践无关。出院前安排PCP随访预约与更多的再入院相关（调整后的比值比，2.20; 95%置信区间，1.08-4.46）。结论：尽管他们的假定值，医院供应商和PCP之间的共同交接做法可能不会导致减少出院后的儿童利用。解决更广泛的结构，如照顾者的自我效能或社会决定因素可能是必要的。(C)2017医院医学学会
BACKGROUND: Improvement in hospital transitional care has become a major national priority, although the impact on children's postdischarge outcomes is unclear.OBJECTIVE: To characterize common handoff practices between hospital and primary care providers (PCPs), and test the hypothesis that common handoff practices would be associated with fewer unplanned readmissions.DESIGN, SETTING, AND PATIENTS: This prospective cohort study enrolled randomly selected pediatric patients during an acute hospitalization at a tertiary children's hospital in 2012-2014.MEASUREMENTS: Primary care and patient data were abstracted from administrative, caregiver, and PCP questionnaires on admission through 30 days postdischarge. The primary outcome was 30-day unplanned readmission to any hospital. Logistic regression assessed relationships between readmissions and 11 handoff communication practices.RESULTS: We enrolled 701 children, from which 685 identified PCPs. Complete data were collected from 84% of PCPs. Communication practices varied widely-verbal handoffs occurred rarely (10.7%); PCP notification of admission occurred for 50.8%. Caregiver experience scores, using an adapted Care Transitions Measure-3, were high but were unrelated to readmissions. Thirty-day unplanned readmissions to any hospital were unrelated to most handoff practices. Having PCP follow-up appointments scheduled prior to discharge was associated with more readmissions (adjusted odds ratio, 2.20; 95% confidence interval, 1.08-4.46).CONCLUSION: Despite their presumed value, common handoff practices between hospital providers and PCPs may not lead to reductions in postdischarge utilization for children. Addressing broader constructs like caregiver self-efficacy or social determinants is likely necessary. (C) 2017 Society of Hospital Medicine