Exploring the utilization of post-discharge care in colorectal surgery patients

项目摘要 手术后再次入院和急诊科(ED)就诊费用高昂，负担沉重。结直肠 手术(CRS)患者在手术后有独特的顾虑，如新造口、伤口护理 问题，并改变了排便习惯。这些担忧增加了他们术后并发症和 需要计划外和资源利用率高的保健服务(UHRHU)，如重新入院和急诊科就诊， 在CRS之后。到目前为止，大多数现有的研究和成功的再入院干预都是有针对性的。 对非手术病人的治疗。检查术后护理的范围的前瞻性数据非常少， 这既包括最佳的医疗保健利用率，如电话接见和诊所就诊，也包括 医疗保健利用率不佳，如计划外再入院和急诊科就诊。 我们建议在30天内检查CRS患者的再入院和ED利用模式 从我们北卡罗来纳州的大型三级学术医院出院。我们将结合电子医疗 通过有针对性的患者访谈记录审查，以获取有关具体方式、原因和地点的新信息 病人接受术后护理。这些数据将共同解释任何特定的风险因素和 CRS后可能影响UHRHU的动机。我们将通过以下目标实现这一目标： 目标1：确定初级外科医生诊所的早期随访是否减少 UHRHU(即重新入院或ED使用)。 目的2：了解患者对出院后护理的利用体验和对 CRS术后护理协调。 目标3：比较和整合CRS患者如何获得其功能的“什么”和“为什么” 出院后护理。 我们希望从这些信息中开发出一种针对CRS患者的有效过渡性护理干预 这将有效地减少不必要的成本、更糟糕的患者结局和相关的不必要负担。 与UHRHU一起。

Project Summary Readmissions and emergency department (ED) visits after surgery are costly and burdensome. Colorectal surgery (CRS) patients in particular have unique concerns after surgery, such as new ostomies, wound care issues, and altered bowel habits. These concerns increase their likelihood of postoperative complications and need for unplanned and high resource health care utilization (UHRHU), such as readmissions and ED visits, after CRS. To date, most existing research and successful interventions for readmission have been targeted towards non-surgical patients. Very little prospective data exist examining the spectrum of postoperative care, which includes both optimal healthcare utilization, such as telephone encounters and clinic visits, as well as suboptimal healthcare utilization, such as unplanned readmissions and ED visits. We propose to examine the readmission and ED utilization patterns of CRS patients within thirty days of discharge from our large, tertiary, academic, North Carolina Hospital. We will combine electronic medical record review with targeted patient interviews to obtain novel information about exactly how, why, and where patients receive their postoperative care. These data collectively will explain any particular risks factors and motives that may influence UHRHU after CRS. We will accomplish this through the following aims: Aim 1: To determine whether or not early follow up with the primary surgeon's clinic decreases UHRHU (i.e. readmission or ED use). Aim 2: To identify the patient experience of postdischarge care utilization and perception of care coordination after CRS. Aim 3: To compare and integrate the “what” and “why” of how CRS patients obtain their postdischarge care. We hope to develop from this information an effective transitional care intervention specific to CRS patients that will be effective for reducing the unnecessary cost, worse patient outcomes, and undue burden associated with UHRHU.