Assessing the Impact of Nurse Post-Discharge Telephone Calls on 30-Day Hospital Readmission Rates
Assessing the Impact of Nurse Post-Discharge Telephone Calls on 30-Day Hospital Readmission Rates
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DOI：
10.1007/s11606-014-2954-2
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发表时间：
2014-11-01
影响因子：
5.7
通讯作者：
Mourad, Michelle
中科院分区：
文献类型：
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作者：
Harrison, James D.;Auerbach, Andrew D.;Mourad, Michelle
一些护理过渡干预措施表明，出院后打电话可以减少不良事件并减少昂贵的回访医院。然而，鉴于大多数护理过渡干预措施的多方面性，现实世界中出院后电话与再入院之间的真实关系尚不确定。为了确定普通医学人群中接到出院后电话对全因 30 天再入院的影响。回顾性观察研究。2010 年 11 月至 2012 年 5 月期间，患者从三级护理学术医疗中心的医疗服务出院回家。患者接受了两次治疗出院后 72 小时内护士尝试拨打电话。护士遵循标准脚本来解决与再入院相关的问题。计费数据捕获再入院。我们使用逻辑回归调整后的患者和临床协变量以及代表被呼叫可能性的倾向评分来确定呼叫接收与再入院风险之间的关联。共有 5,507 名符合条件的患者。在未经调整的分析中，与未完成干预的患者相比，接到电话并完成干预的患者再次入院的可能性显着降低[155 (5.8 %) vs 123 (8.6 %)，p < 0.01]。在仅调整社会人口统计学和临床协变量的多变量模型中，完成出院后电话干预与较低的再入院几率相关（AOR 0.71；95% CI：0.55-0.91）。然而，当使用倾向评分调整模型接听电话的可能性时，没有观察到接听电话与再次入院之间存在关联（AOR 0.91；95%CI：0.69-1.20）。出院后电话通话计划的有效性可能更与患者是否能够接听电话相关，而不是与电话提供的护理相关。项目将受益于提高他们进行电话外展的能力，同时改善电话期间提供的护理。
Several care transition interventions propose that post-discharge phone calls can reduce adverse events and decrease costly return visits to the hospital. However, given the multi-faceted nature of most care transitions interventions, the true relationship between post-discharge phone calls and readmissions in a real world setting is uncertain.To determine the effect of receiving a post-discharge telephone call on all-cause 30-day readmission in a general medicine population.Retrospective observational study.Patients discharged home from the Medicine Service at a tertiary care academic medical center between November 2010 and May 2012.Patients received two telephone call attempts by a nurse within 72 h of discharge. Nurses followed a standard script to address issues associated with readmission.Billing data captured readmissions. We used logistic regression-adjusted patient and clinical covariates as well as a propensity score representing likelihood of being called to determine the association between call receipt and risk for readmission.There were 5,507 eligible patients. In unadjusted analyses, patients who received a call and completed the intervention were significantly less likely to be readmitted compared to those who did not [155 (5.8 %) vs 123 (8.6 %), p < 0.01]. In multivariable models adjusting for socio-demographic and clinical covariates alone, completing a post-discharge telephone call intervention was associated with lower odds for readmission (AOR 0.71; 95 % CI: 0.55-0.91). However, when models adjusted for the likelihood of receiving the phone call using the propensity score, no association between call receipt and readmission was observed (AOR 0.91; 95%CI: 0.69-1.20).Effectiveness of post-discharge phone call programs may be more related to whether patients are able to answer a phone call than to the care delivered by the phone call. Programs would benefit from improving their ability to perform phone outreach while simultaneously improving on the care delivered during the calls.