Reducing Readmissions After Stroke With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program
Reducing Readmissions After Stroke With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program
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DOI：
10.1161/strokeaha.115.012524
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发表时间：
2016-06-01
期刊：
影响因子：
8.3
通讯作者：
Bushnell, Cheryl
中科院分区：
文献类型：
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作者：
Condon, Christina;Lycan, Sarah;Bushnell, Cheryl
背景和目的，我们的目的是确定是否一个标准化的过渡性中风诊所（TSC）领导的执业护士可以减少30天和90天的再入院中风或短暂性脑缺血发作患者出院home.Methods-Phase I包括执业护士呼吁只有高风险的患者出院回家7天内，并在出院后2至4周内进行一次办公室访问。第II阶段包括所有出院回家的患者接受注册护士的2天随访电话和执业护士在7至14天内的随访访视。评估了2个阶段和总体过程指标和再入院的差异。多种慢性疾病（糖尿病、冠状动脉疾病和充血性心力衰竭）的复杂性增加，以0 - 3的连续变量表示。对30天和90天再入院进行多变量logistic回归模型，并对美国国立卫生研究院卒中量表（NIHSS）和既往住院情况进行调整。从I期到II期，进行了更高比例的随访电话，从出院到TSC的天数减少。30天内再次入院的患者不太可能出现TSC访视（60.85% vs 76.3%; P = 0.021）。多变量建模显示，TSC就诊与30天再入院率减少48%相关（比值比，0.518; 95%置信区间，0.272-0.986），而多种慢性病和既往中风/短暂性脑缺血发作会增加风险。TSC访问并没有影响90天reincidations.Conclusions-Evaluation在一个护士护理师领导的结构化诊所是一个模型，可以减少再入院在30天的中风患者出院回家。
Background and Purpose-Our aim was to determine whether a standardized Transitional Stroke Clinic (TSC) led by nurse practitioners could reduce 30-day and 90-day readmissions for stroke or transient ischemic attack patients discharged home.Methods-Phase I consisted of nurse practitioners calling only high-risk patients discharged home within 7 days and performing an office visit within 2 to 4 weeks of discharge. Phase II consisted of all patients discharged home receiving both a 2-day follow-up phone call by a registered nurse and a follow-up visit with a nurse practitioner within 7 to 14 days. Differences in process metrics and readmissions across the 2 phases and overall were assessed. Increasing complexity with multiple chronic conditions (diabetes mellitus, coronary artery disease, and congestive heart failure) was represented in a continuous variable from 0 to 3. Multivariable logistic regression models for 30-day and 90-day readmissions were performed with adjustment for National Institutes of Health Stroke Scale (NIHSS) and previous hospitalizations.Results-From October 2012 through September 2015, 510 patients were enrolled. From phase I to II, a higher proportion of follow-up calls were made and days from discharge to TSC decreased. Patients readmitted within 30 days were less likely to show for TSC visits (60.85% versus 76.3%; P = 0.021). Multivariable modeling showed that TSC visit was associated with a 48% reduction in 30-day readmission (odds ratio, 0.518; 95% confidence interval, 0.272-0.986), whereas multiple chronic conditions and previous stroke/transient ischemic attack increased the risk. TSC visit did not impact 90-day readmissions.Conclusions-Evaluation in a nurse practitioner-led structured clinic is a model that may reduce readmissions at 30 days for stroke patients discharged home.