Visit Entropy Associated with Hospital Readmission Rates
Visit Entropy Associated with Hospital Readmission Rates
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DOI：
10.3122/jabfm.2017.01.160186
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发表时间：
2017-01-01
影响因子：
2.9
通讯作者：
Pecina, Jennifer
中科院分区：
文献类型：
--
作者：
Garrison, Gregory M.;Keuseman, Rachel;Pecina, Jennifer
目的：慢性病模型表明，护理的连续性和基于团队的护理可以改善多发性硬化症患者的预后并减少住院治疗。入院后的连续性护理对再入院率的影响好坏参半，然而，其入院前的效果还没有得到很好的研究。增加门诊护理组织和连续性入院前的假设，以减少recremits.Methods的几率：在一个队列的14,662初级保健患者从病人为中心的医疗之家（PCMH）的做法，连续性的护理入院前12个月进行评估，使用3个既定的指标;通常提供者连续性（UPC）、分散护理连续性（COC）和序列连续性（SECON）。此外，由于这些既定的指标可能无法准确反映计划的团队为基础的护理的连续性，一个新的指标称为访问熵（VE）被用来量化访问的混乱。进行多变量logistic回归分析，以检查30天内再入院和连续性之间的关系，同时控制已知的再入院风险因素提取的电子病历。结果：较高的VE与再入院（比值比，1.10; 95%置信区间，1.02至1.19）。UPC，COC，和SECON的连续性措施与再入院无关。结论：混乱的医疗护理，其特点是较高的VE，与住院的初级保健患者再入院的几率较高。传统的连续性措施（UPC，COC和SECON）和再入院之间的关联没有被发现。
Purpose: The chronic disease model suggests continuity of care and team-based care can improve outcomes for multimorbidity patients and reduce hospitalizations. Continuity of care following admission has had mixed effects on readmission rates; however, its effect before admission has not been well studied. Increased outpatient care organization and continuity before admission is hypothesized to reduce the odds of readmission.Methods: In a cohort of 14,662 primary care patients from a Patient-Centered Medical Home (PCMH) practice, continuity of care in the 12 months before admission was assessed using 3 established metrics; usual provider continuity (UPC), dispersion continuity of care (COC), and sequence continuity (SECON). In addition, because these established metrics may not accurately reflect continuity in planned team-based care, a new metric called visit entropy (VE) was used to quantify the disorganization of visits. Multivariate logistic regression was performed to examine the relationship between readmission within 30 days and continuity while controlling for known readmission risk factors abstracted from an electronic medical record.Results: Higher VE was associated with readmission (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19). The continuity measures of UPC, COC, and SECON were not associated with readmission.Conclusions: Disorganized medical care, characterized by a higher VE, is associated with higher odds of readmission among hospitalized primary care patients. An association between traditional measures of continuity (UPC, COC, and SECON) and readmission was not found.