Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults
Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults
复制标题
DOI：
10.1186/s12913-018-3771-9
复制
发表时间：
2018-12-12
影响因子：
2.8
通讯作者：
O'Brien, Jane
中科院分区：
文献类型：
--
作者：
Finlayson, Kathleen;Chang, Anne M.;O'Brien, Jane
背景急性医院服务占卫生保健系统预算的最大比例，老年人是最频繁的用户。因此，最近出院的老年人可能面临更大的再入院风险。本研究的目的是评估比较有效的过渡性护理干预措施计划外再入院28天内，12周和24周后hospitalreflease.MethodThe本研究是一项随机对照试验（ACTRN 12608000202369）。该试验涉及222名参与者，他们是从澳大利亚两家大都市医院的内科病房招募的。如果参与者年龄在65岁及以上，有医疗诊断并且至少有一个再入院的风险因素，则有资格入选。参与者被随机分配到四组之一：标准护理，仅锻炼计划，护士家庭访问和电话随访（N-HaT），或锻炼计划和护士家庭访问和电话随访（ExN-HaT）。在基线、28天、12周和24周时评估社会人口统计学、健康和功能能力。结果ExN-HaT组和N-HaT组患者在出院后28天内再次入院的可能性分别为对照组的3.6倍和2.6倍（ExN-HaT组HR 0.28，95%CI 0.09-0.87，p=0.029; N-HaT组HR 0.38，95%CI 0.13-1.07，p=0.067）。ExN-HaT或N-HaT组受试者在出院后12周内发生计划外再入院的可能性分别低2.13倍和2.63倍（ExN-HaT组HR 0.47，95% CI 0.23-0.97，p=0.014; N-HaT组HR 0.38，95% CI 0.18-0.82，p=0.040）。出院后24周，groups.ConclusionMultifaceted过渡期护理干预在医院和社区设置是有益的，与较低的再入院率观察到那些接受更多的过渡期干预组件，虽然只有在第12周。
BackgroundAcute hospital services account for the largest proportion of health care system budgets, and older adults are the most frequent users. As a result, older people who have been recently discharged from hospital may be at greater risk of readmission. This study aims to evaluate the comparative effectiveness of transitional care interventions on unplanned hospital readmissions within 28days, 12weeks and 24weeks following hospital discharge.MethodThe present study was a randomised controlled trial (ACTRN12608000202369). The trial involved 222 participants who were recruited from medical wards in two metropolitan hospitals in Australia. Participants were eligible for inclusion if they were aged 65years and over, admitted with a medical diagnosis and had at least one risk factor for readmission. Participants were randomised to one of four groups: standard care, exercise program only, Nurse Home visit and Telephone follow-up (N-HaT), or Exercise program and Nurse Home visit and Telephone follow-up (ExN-HaT). Socio-demographics, health and functional ability were assessed at baseline, 28days, 12weeks and 24weeks. The primary outcome measure was unplanned hospital readmission which was defined as any hospital admission for an unforeseen or unplanned cause.ResultsParticipants in the ExN-HaT or the N-HaT groups were 3.6 times and 2.6 times respectively significantly less likely to have an unplanned readmission 28days following discharge (ExN-HaT group HR 0.28, 95% CI 0.09-0.87, p=0.029; N-HaT group HR 0.38, 95% CI 0.13-1.07, p=0.067). Participants in the ExN-HaT or the N-HaT groups were 2.13 and 2.63 times respectively less likely to have an unplanned readmission in the 12weeks after discharge (ExN-HaT group HR 0.47, 95% CI 0.23-0.97, p=0.014; N-HaT group HR 0.38, 95% CI 0.18-0.82, p=0.040). At 24weeks after discharge, there were no significant differences between groups.ConclusionMultifaceted transitional care interventions across hospital and community settings are beneficial, with lower hospital readmission rates observed in those receiving more transitional intervention components, although only in first 12weeks.Trial registrationAustralian and New Zealand Clinical Trial Registry (ACTRN12608000202369).