PREDICTORS OF FORMAL HOME HEALTH-CARE USE IN ELDERLY PATIENTS AFTER HOSPITALIZATION
PREDICTORS OF FORMAL HOME HEALTH-CARE USE IN ELDERLY PATIENTS AFTER HOSPITALIZATION
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DOI：
10.1111/j.1532-5415.1993.tb06762.x
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发表时间：
1993-09-01
影响因子：
6.3
通讯作者：
INOUYE, SK
中科院分区：
文献类型：
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作者：
SOLOMON, DH;WAGNER, DR;INOUYE, SK
目的：前瞻性研究急性护理出院的老年内科和外科患者使用家庭医疗保健（HHC）的发生率和风险因素。虽然HHC在这组患者中很常见，但其预测因子尚未得到很好的研究。设计：前瞻性队列研究。设置：一所大学教学医院的内科和外科病房，随后是研究集水区的23家Medicare认证的HHC机构。患者：226名年龄在70岁及以上的内科和外科患者，从急性护理出院后立即进行测量。HHC出院后14天内启动，测量HHC机构records.Results的直接审查：出院后2周内启动HHC的发病率为75/226（34%）。中位服务时间为30天（范围3-483），每周中位访视3次。通过多因素分析确定了4个独立的HHC预测因素：教育水平≤ 12年（相对风险（RR）3.3; 95%置信区间（CI）1.6至6.6）;社会支持较少（RR，1.7; CI 0.9 - 3.1）;至少一种工具性日常生活活动受损（RR，1.9; CI，1.0，3.4）;既往使用HHC（RR，2.1; CI，1.2 - 3.6）。通过为存在的每个风险因素增加一个点来创建风险分层：0-1个风险因素，8%使用HHC; 2个风险因素，28%; 3个风险因素，45%，4个风险因素，76%。这一趋势具有统计学意义（P < 0.001）。结论：HHC的使用是常见的老年患者出院后，从急性护理。基于四个风险因素的简单预测模型可以在入院时用于预测HHC的使用。该模型可用于老年人的出院规划和医疗服务利用规划。
Objective: To prospectively study the incidence of and risk factors for home health care (HHC) use in a cohort of elderly medical and surgical patients discharged from acute care. Although HHC is commonly received by patients in this group, its predictors have not been well studied.Design: Prospective cohort study.Setting: Medical and surgical wards at a university teaching hospital, followed by 23 Medicare-certified HHC agencies in the study catchment area.Patients: 226 medical and surgical patients aged 70 years and older immediately after discharge from acute care.Measurements: HHC initiated within 14 days after hospital discharge, measured by direct review of HHC agency records.Results: The incidence of HHC initiated within 2 weeks post-discharge was 75/226 (34%). The median duration of service was 30 days (range 3-483) with a median of 3 visits per week. Four independent predictors of HHC were identified through multivariate analysis: educational level less-than-or-equal-to 12 years (relative risk (RR) 3.3; 95% confidence interval (CI) 1.6 to 6.6); less accessible social support (RR, 1.7; CI 0.9 to 3.1); impairment in at least one instrumental activity of daily living (RR, 1.9; CI, 1.0, 3.4); and prior HHC use (RR, 2.1; Cl, 1.2 to 3.6). Risk strata were created by adding one point for each risk factor present: with 0-1 risk factors, 8% used HHC; with two risk factors, 28%; with three risk factors, 45%, with four risk factors, 76%. This trend was statistically significant (P < 0.001).Conclusions: HHC use is common among elderly patients after discharge from acute care. A simple predictive model based on four risk factors can be used on admission to predict HHC use. This model may be useful for discharge planning and health care utilization planning for the elderly population.