退院后虚拟病房对高风险患者再入院或死亡的影响:一项随机临床试验
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
概括
虚拟病房,社区患者的医院护理模式,与常规护理相比,没有显著减少高风险个体的住院再入院或死亡. 需要进一步的研究来探索减少再接收率的替代策略.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 老年医学 老年医学
- 内部医学 内部医学
背景情况:
- 医院再入院是一个重大的问题,如果没有一贯有效的干预措施,就会产生大量成本.
- 虚拟病房,将医院级护理扩展到社区,显示出减少再入院的潜力,但需要严格的评估.
研究的目的:
- 评估虚拟病房模型,为社区住院患者提供专业间护理,是否可以降低高风险个体退院后再入院或死亡的风险.
主要方法:
- 一项随机对照试验涉及1923名高风险成年患者,他们从多伦多医院出院.
- 患者被分配到虚拟病房 (护理协调和直接的跨专业团队护理) 或常规护理.
- 主要结局是医院再入院或30天内死亡的组合,随着延长后续到1年.
主要成果:
- 对于30天,90天,6个月或1年后的首要结果 (再入院或死亡),虚拟病房和通常护理组之间没有观察到统计学上显著的差异.
- 主要结局发生在21.2%的虚拟病房患者中,而常规护理患者中为24.6% (P=.09).
- 没有发现任何显著的子组影响,这表明在不同患者资料中持续缺乏益处.
结论:
- 虚拟病房护理模型没有显示出在医院出院后降低高风险患者再入院或死亡率的统计学上显著影响.
- 这些发现表明,这种特定的虚拟病房干预可能不是这种患者群体通常护理的优越替代方案.
- 对优化虚拟病房设计或替代干预措施的进一步研究是有必要的,以应对医院再入院的挑战.
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