Transitional care clinics for follow-up and primary care linkage for patients discharged from the ED
Transitional care clinics for follow-up and primary care linkage for patients discharged from the ED
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DOI：
10.1016/j.ajem.2016.03.029
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发表时间：
2016-07-01
影响因子：
3.6
通讯作者：
Sabbatini, Amber K.
中科院分区：
文献类型：
--
作者：
Elliott, Kailyn;Klein, Jared W.;Sabbatini, Amber K.
目的：过渡护理诊所（tcc）代表了一种策略，以促进从急诊科（ED）出院的没有常规护理来源的患者的随访和初级保健联系。我们评估了这些患者完成TCC随访的相关因素，并描述了他们随后使用ED的特征。方法：对660例随机抽样的患者进行回顾性研究，这些患者在ED出院时预约了TCC。从这些患者的医疗记录中提取患者和访问级别的特征，并与国事访问数据库相关联，以表征转诊后的ED使用情况。采用多元逻辑回归来确定与随访完成和后续ED使用相关的因素。结果：一半（50%）的患者完成了随访预约，平均随访时间为6.9天。非英语语言（优势比[OR]， 2.21；置信区间[CI]， 1.30-3.75）是改善随访的唯一因素；然而，无家可归的患者（OR, 0.42； CI, 0.26-0.66）有药物使用史（OR, 0.68； CI, 0.45-1.00），以及基线ED就诊次数较多的患者（OR， 0.94 /次ED就诊；CI, 0.89-0.99）完成随访的可能性明显较低。在调整了人口统计学、临床和就诊水平特征后，完成预约的患者与未完成预约的患者相比，在随后的一年里，急诊科就诊次数明显减少（平均2.3次vs 3.3次；差异为-1.0次；差异CI为-1.2至-0.7）。结论：过渡护理诊所是一种有希望的策略，可以提高急诊患者护理的连续性，并可能减少不必要的急诊科使用。Elsevier Inc.出版。
Objectives: Transitional care clinics (TCCs) represent one strategy to facilitate follow-up and primary care linkage for patients with no regular source of care who are discharged from the emergency department (ED). We assessed factors associated with completion of TCC follow-up among these patients and characterized their subsequent ED use.Methods: Retrospective study of 660 randomly sampled patientswith a scheduled appointment to a TCC at time of ED discharge. Patient-and visit-level characteristics were abstracted from the medical records of these patients and linked to a state visit database to characterize ED use after referral. Multiple logistic regression was used to determine factors associated with completion of follow-up and subsequent ED utilization.Results: Half (50%) of the patients completed their follow-up appointment with a mean follow-up time of 6.9 days. Non-English language (odds ratio [OR], 2.21; confidence interval [CI], 1.30-3.75) was the only factor associated with improved follow-up; however, patients who were homeless (OR, 0.42; CI, 0.26-0.66) had a substance use history (OR, 0.68; CI, 0.45-1.00), and those with more baseline ED visits (OR, 0.94 per additional ED visit; CI, 0.89-0.99) were significantly less likely to complete follow-up. After adjusting for demographic, clinical, and visit-level characteristics, patients who completed their appointment had significantly fewer ED visits in the subsequent year compared to patients who did not complete their appointment (mean, 2.3 vs 3.3 visits; difference, -1.0 visits in subsequent calendar year; CI for difference, -1.2 to -0.7).Conclusion: Transitional care clinics represent a promising strategy to improve the continuity of care for emergency patients and may reduce unnecessary ED use. Published by Elsevier Inc.