Does Early Follow-Up Improve the Outcomes of Sepsis Survivors Discharged to Home Health Care?
Does Early Follow-Up Improve the Outcomes of Sepsis Survivors Discharged to Home Health Care?
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DOI：
10.1097/mlr.0000000000001152
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发表时间：
2019-08-01
期刊：
影响因子：
3
通讯作者：
Feldman, Penny H.
中科院分区：
文献类型：
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作者：
Deb, Partha;Murtaugh, Christopher M.;Feldman, Penny H.
背景：尽管再入院率很高，但很少有证据指导100多万脓毒症幸存者出院后的护理。目的：我们研究早期家庭健康护理（出院后2天内首次就诊，出院后第一周至少1次额外就诊）和早期医生随访（出院后第一周门诊就诊）是否能减少医疗败血症幸存者30天的再入院率。设计：使用非线性工具变量分析对2013年至2014年的医疗保险数据进行实用的比较有效性分析。对象：50个州和哥伦比亚特区的医疗保险受益人在败血症住院治疗后活着出院并接受家庭保健。测量方法：结果、方案参数和控制变量来自医疗保险管理和索赔文件以及家庭健康结果和评估信息集（OASIS）。主要终点为30天全因再入院。结果：我们的样本包括170,571例，主要是非西班牙裔白人（82.3%），女性（57.5%），老年人（平均年龄，76岁），严重脓毒症（86.9%）和多种合并症和功能限制。其中，仅接受护理方案的占44.7%，仅接受医生方案的占11.0%，同时接受两种方案的占28.1%，两者均不接受的占16.2%。虽然两种方案本身对再入院的影响都没有统计学意义，但两者共同使30天全因再入院的概率降低了7个百分点（P=0.006； 95%置信区间= 2,12）。结论：我们的研究结果表明，家庭健康和医疗服务提供者的早期出院后护理可以减少败血症幸存者的再入院率。
Background: There is little evidence to guide the care of over a million sepsis survivors following hospital discharge despite high rates of hospital readmission. Objective: We examined whether early home health nursing (first visit within 2 days of hospital discharge and at least 1 additional visit in the first posthospital week) and early physician follow-up (an outpatient visit in the first posthospital week) reduce 30-day readmissions among Medicare sepsis survivors. Design: A pragmatic, comparative effectiveness analysis of Medicare data from 2013 to 2014 using nonlinear instrumental variable analysis. Subjects: Medicare beneficiaries in the 50 states and District of Columbia discharged alive after a sepsis hospitalization and received home health care. Measures: The outcomes, protocol parameters, and control variables were from Medicare administrative and claim files and the home health Outcome and Assessment Information Set (OASIS). The primary outcome was 30-day all-cause hospital readmission. Results: Our sample consisted of 170,571 mostly non-Hispanic white (82.3%), female (57.5%), older adults (mean age, 76 y) with severe sepsis (86.9%) and a multitude of comorbid conditions and functional limitations. Among them, 44.7% received only the nursing protocol, 11.0% only the medical doctor protocol, 28.1% both protocols, and 16.2% neither. Although neither protocol by itself had a statistically significant effect on readmission, both together reduced the probability of 30-day all-cause readmission by 7 percentage points (P=0.006; 95% confidence interval=2, 12). Conclusions: Our findings suggest that, together, early postdischarge care by home health and medical providers can reduce hospital readmissions for sepsis survivors.