退院後の仮想病棟が,高リスク患者の再入院や死亡に与える影響:ランダム化臨床試験
Irfan A Dhalla1, Tara O'Brien2, Dante Morra3
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto3Department of Medicine, St Michael's Hospital, Toronto4Li Ka Shing Knowledge Institute of St Mich.
JAMA
|October 1, 2014
まとめ
コミュニティ患者のための病院ケアモデルである仮想病棟は,通常のケアと比較して,高リスクの患者の再入院や死亡を大幅に減少させませんでした. 再入国率を下げるための代替戦略を探るため,さらなる研究が必要である.
科学分野:
- 医療サービス 研究 医療サービス
- ゲリアトリック・メディシン (老年医学)
- 内科内科は,内科の内科である.
背景:
- 病院再入院は大きな懸念事項であり,一貫して効果的な介入がなければ,かなりの費用がかかります.
- 仮想病棟は,病院レベルのケアをコミュニティに拡張し,再入院を減らす可能性を示していますが,厳格な評価が必要です.
研究 の 目的:
- コミュニティで暮らす患者にインタープロフェッショナルケアを提供する仮想病棟モデルが,退院後,高リスクの患者に再入院または死亡のリスクを軽減できるかどうかを評価する.
主な方法:
- トロントの病院から退院した1923人の高リスク成人の患者を対象としたランダム化制御試験.
- 患者は,仮想病棟 (ケアコーディネーションと直接的なインタープロフェッショナルチームケア) または通常のケアに割り当てられました.
- 主なアウトカムは,再入院または30日以内に死亡の複合体であり,追跡期間が1年まで延長されました.
主要な成果:
- 30日,90日,6ヶ月,または1年後の主要なアウトカム (再入院または死亡) について,仮想病棟と通常のケアグループの間で統計的に有意な差異は観察されなかった.
- プライマリアウトカムは,仮想病棟患者の21.2%で,通常のケア患者の24.6%で発生しました (P=.09).
- 重要なサブグループ効果は見つかりませんでしたが,これはさまざまな患者プロファイルで一貫して利益がないことを示しています.
結論:
- 医療の仮想病棟モデルは,高リスク患者の再入院や退院後の死亡率を減らすのに統計的に有意な効果を示さなかった.
- この発見は,この特定の仮想病棟の介入が,この患者集団の通常のケアに対する優れた代替案ではないかもしれないことを示唆しています.
- 病院再入院の課題に取り組むために,最適化された仮想病棟設計や代替的介入に関するさらなる調査が必要である.
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