Patient Activation and 30-Day Post-Discharge Hospital Utilization
Patient Activation and 30-Day Post-Discharge Hospital Utilization
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DOI：
10.1007/s11606-013-2647-2
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发表时间：
2014-02-01
影响因子：
5.7
通讯作者：
Paasche-Orlow, Michael K.
中科院分区：
文献类型：
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作者：
Mitchell, Suzanne E.;Gardiner, Paula M.;Paasche-Orlow, Michael K.
患者激活与更好的健康结果和更低的卫生服务利用率有关。出院后30天内患者激活对再入院率的作用尚未得到检验。使用在城市安全网医院进行的项目RED-LIT随机对照试验数据进行的二次分析。资料来自695名以英语为母语的普通内科住院病人。我们使用了经过验证的患者激活测量（PAM）的调整后的八项版本。根据标准化方法，将总分分类为四个PAM激活水平之一：1级（最低激活）至4级（最高激活）。主要结局指标是出院后30天的总医院利用率，定义为急诊科（艾德）总就诊次数加上再入院率（包括观察期）。在695例受试者中，67例（9.6%）为PAM 1级，123例（17.7%）为2级，193例（27.8%）为3级，312例（44.9%）为4级。与高活化患者（PAM 4级）相比，在较低活化水平（PAM 1级，发病率比[IRR] 1.75，95% CI，1.18 - 2.60）和（PAM 2级，IRR 1.50，95% CI 1.06 - 2.13）的患者中观察到出院后30天的医院利用率较高。PAM 3级患者与PAM 4级患者的返回医院率无统计学差异（IRR 1.30，95% CI，0.94 - 1.80）。对于单独使用艾德（1.68 [1.07 - 2.63]）和单独再入院（1.93 [1.22 - 3.06]），PAM 1级的比率也高于4级。在患者激活水平较低的城市学术安全网医院住院的成人医疗患者出院后30天的医院利用率较高。
Patient activation is linked to better health outcomes and lower rates of health service utilization. The role of patient activation in the rate of hospital readmission within 30 days of hospital discharge has not been examined.A secondary analysis using data from the Project RED-LIT randomized controlled trial conducted at an urban safety net hospital. Data from 695 English-speaking general medical inpatient subjects were analyzed. We used an adapted, eight-item version of the validated Patient Activation Measure (PAM). Total scores were categorized, according to standardized methods, as one of four PAM levels of activation: Level 1 (lowest activation) through Level 4 (highest activation). The primary outcome measure was total 30-day post-discharge hospital utilization, defined as total emergency department (ED) visits plus hospital readmissions including observation stays. Poisson regression was used to control for confounding.Of the 695 subjects, 67 (9.6 %) were PAM Level 1, 123 (17.7 %) were Level 2, 193 (27.8 %) were Level 3, and 312 (44.9 %) were Level 4. Compared with highly activated patients (PAM Level 4), a higher rate of 30-day post-discharge hospital utilization was observed for patients at lower levels of activation (PAM Level 1, incident rate ratio [IRR] 1.75, 95 % CI,1.18 to 2.60) and (PAM Level 2, IRR 1.50, 95 % CI 1.06 to 2.13). The rate of returning to the hospital among patients at PAM Level 3 was not statistically different than patients with PAM Level 4 (IRR 1.30, 95 % CI, 0.94 to 1.80). The rate ratio for PAM Level 1 was also higher compared with Level 4 for ED use alone (1.68(1.07 to 2.63)) and for hospital readmissions alone (1.93 [1.22 to 3.06]).Hospitalized adult medical patients in an urban academic safety net hospital with lower levels of Patient Activation had a higher rate of post-discharge 30-day hospital utilization.