Using Short Stay Units (SSU) Instead of Routine Admission to Improve Patient Centered Health Outcomes for Acute Heart Failure (AHF) Patients.

标题：使用短期住院单位，而不是常规入院，以改善患者为中心的健康结果， 急性心力衰竭患者 摘要 近85%的急性心力衰竭（AHF）患者在急诊科（艾德）就诊时， 心力衰竭（AHF）住院治疗。一旦住院，在出院后30天内，27%的患者再次住院。 住院或死亡。尝试用新的疗法来改善结果都失败了。的证据 现有的AHF治疗效果不佳：目前没有已知的AHF治疗可以改善预后。艾德 今天的治疗与40年前基本相同。住院治疗不需要的病人可能会导致 不良后果。住院不是良性的;患者在出院后进入脆弱期， 增加发病率和死亡率的风险。病人更愿意呆在家里，而不是住院。此外，委员会认为， AHF的住院和再住院主要影响社会经济地位较低的患者 （SES）。避免不需要住院的患者住院可能会改善预后和生活质量， 降低成本。 短期住院单元（SSU：少于24小时）管理AHF对低风险患者有效。但是， 仅在小型研究或回顾性分析中进行了研究。此外，SSU被认为是“作弊” 对于试图避免30天再入院处罚的医院来说，因为SSU或观察不算作 入院然而，这种质量标准正在发生变化。一个强大的临床有效性试验将 证明这种以病人为中心的策略的有效性。

Title: Using Short Stay Units Instead of Routine Admission to Improve Patient Centered Health Outcomes for Acute Heart Failure Patients ABSTRACT Nearly 85% of acute heart failure (AHF) patients who present to the emergency department (ED) with acute heart failure (AHF) are hospitalized. Once hospitalized, within 30 days post-discharge, 27% of patients are re- hospitalized or die. Attempts to improve outcomes with novel therapies have all failed. The evidence for existing AHF therapies are poor: No currently used AHF treatment is known to improve outcomes. ED treatment is largely the same today as 40 years ago. Hospitalizing patients who don't need it may contribute to adverse outcomes. Hospitalization is not benign; patients enter a vulnerable phase post-discharge, at increased risk for morbidity and mortality. Patients would prefer to be home, not hospitalized. Furthermore, hospitalization and re-hospitalization for AHF predominantly affects patients of lower socioeconomic status (SES). Avoiding hospitalization in patients who don't need it may improve outcomes and quality of life, while reducing costs. Short stay unit (SSU: less than 24 hours) management of AHF is effective for lower risk patients. However, it's only been studied in small studies or retrospective analyses. In addition, SSU have been considered `cheating' for hospitals trying to avoid 30 day readmission penalties, since SSU or observation didn't count as an admission. However, this quality measure is now changing. A robust clinical effectiveness trial would demonstrate the effectiveness of this patient-centered strategy.