Correlation of patient complexity with the burden for health-related professions, and differences in the burden between the professions at a Japanese regional hospital: a prospective cohort study
Correlation of patient complexity with the burden for health-related professions, and differences in the burden between the professions at a Japanese regional hospital: a prospective cohort study
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患者复杂性与健康相关专业负担的相关性以及日本地区医院各专业之间负担的差异：一项前瞻性队列研究
DOI：
10.1136/bmjopen-2018-025176
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发表时间：
2019
期刊：
影响因子：
2.9
通讯作者：
Y. Fujinuma
中科院分区：
文献类型：
--
作者：
Shuhei Yoshida;M. Matsushima;H. Wakabayashi;R. Mutai;Y. Sugiyama;Toshifumi Yodoshi;Ryoko Horiguchi;Takamasa Watanabe;Y. Fujinuma
目的老龄化社会包括高度的患者复杂性。各种生物、心理和社会问题给卫生相关专业人员带来了沉重的负担。然而，负担与患者复杂性之间的直接关系尚未报道。我们的目的是检验主治医生和护士的负担与患者复杂性的以患者为中心的评估方法(PCAM)得分之间的相关性。设计前瞻性队列研究。在日本设立一家地区性二级护理医院。参与者我们包括2014年7月1日至2014年9月30日期间在我们的急性护理病房住院的所有患者。排除标准是年龄和20岁、拒绝参加研究和在入院时固定的逗留时间。入院初期PCAM总分的主要预测因素。主要结果：每个职业的负担(以视觉模拟量表衡量)。结果201例住院患者中，女性98例，男性98例，平均年龄(SD)77.4±11.9岁。Spearman‘s等级相关系数在0.23~0.32之间。所有P值均为<；0.05。使用多水平混合效应线性回归进行多变量分析，以确定两个模型中负担与PCAM得分之间的关联。模型1使用PCAM总分作为预测变量。模型2使用以患者为中心的复杂性和以药物为中心的复杂性这两个PCAM因素作为预测变量。在模型2中，在医生负担的情况下，以药物为导向的复杂性在统计上显著，而在护士的负担下，年龄和以病人为导向的复杂性在统计上都显著。结论PCAM得分与医护人员的工作负担相关。个人PCAM因素对每个职业的负担有不同程度的影响。
Objectives An ageing society includes high patient complexity. Various biopsychosocial problems result in a high burden for health-related professionals. The direct relationship between the burden and patient complexity, however, has not been reported. We aimed to examine correlations between the burden for the attending physicians and nurses, and Patient Centred Assessment Method (PCAM) scores of patient complexity. Design Prospective cohort study. Setting A regional secondary care hospital in Japan. Participants We included all inpatients admitted to our acute care unit between 1 July 2014 and 30 September 2014. Exclusion criteria were age <20 years, refusal to participate in the study and length of stay fixed at the time of admission. Main predictor PCAM total score in the initial phase of hospital admission. Main outcome The burden for each profession (measured on a Visual Analogue Scale). Results In total, 201 inpatients participated [female/male=98/103, mean (SD) age of 77.4±11.9 years]. Spearman’s rank correlation coefficients between the burden and the PCAM score ranged from 0.23 to 0.32. All p values were <0.05. Multivariate analysis was conducted using multilevel mixed-effects linear regression to determine the association between the burden and the PCAM score in two models. Model 1 used the total PCAM score as the predictive variable. Model 2 used the PCAM factors, patient-oriented complexity and medicine-oriented complexity, as predictive variables. In Model 2, with the burden of physicians, medicine-oriented complexity was statistically significant, whereas with the burden of nurses, both age and patient-oriented complexity were statistically significant. Conclusions PCAM scores correlated with the burden for physicians and nurses. Individual PCAM factors affected the burden for each profession differently.