Home Health Care: Nurse-Physician Communication, Patient Severity, and Hospital Readmission
Home Health Care: Nurse-Physician Communication, Patient Severity, and Hospital Readmission
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DOI：
10.1111/1475-6773.12667
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发表时间：
2018-04-01
影响因子：
3.4
通讯作者：
Press, Matthew J.
中科院分区：
文献类型：
--
作者：
Pesko, Michael F.;Gerber, Linda M.;Press, Matthew J.
目的评价家庭护理护士和医生在出院后的家庭护理过程中的沟通失败是否与再次入院有关。数据来源/研究设置我们将2008年和2009年纽约充血性心力衰竭患者的电子病历访问护士服务与医疗保险服务费受益者的住院索赔数据联系起来。研究设计采用线性回归模型和倾向分数匹配方法评估沟通失败与30天再入院的关系，数据收集/提取方法对电子病历中的自由文本数据进行自然语言处理，以确定家庭保健护士与医生之间的沟通失败。主要发现，沟通失败与高危患者再次入院的概率(平均值的32.6%)有统计学意义的9.7个百分点的增加。结论家庭健康护士与医生之间沟通不畅与高危患者再次入院的风险增加有关。减少这一群体重新入院的努力应考虑将注意力集中在这一因素上。
ObjectiveTo evaluate whether communication failures between home health care nurses and physicians during an episode of home care after hospital discharge are associated with hospital readmission, stratified by patients at high and low risk of readmission.Data Source/Study SettingWe linked Visiting Nurse Services of New York electronic medical records for patients with congestive heart failure in 2008 and 2009 to hospitalization claims data for Medicare fee-for-service beneficiaries.Study DesignLinear regression models and a propensity score matching approach were used to assess the relationship between communication failure and 30-day readmission, separately for patients with high-risk and low-risk readmission probabilities.Data Collection/Extraction MethodsNatural language processing was applied to free-text data in electronic medical records to identify failures in communication between home health nurses and physicians.Principal FindingsCommunication failure was associated with a statistically significant 9.7 percentage point increase in the probability of a patient readmission (32.6 percent of the mean) among high-risk patients.ConclusionsPoor communication between home health nurses and physicians is associated with an increased risk of hospital readmission among high-risk patients. Efforts to reduce readmissions among this population should consider focusing attention on this factor.