无家可归的患者中的危急疾病:回顾性队列研究
K M Sauro1, C M O'Rielly2, J Kersen3
1Departments of Community Health Sciences, Surgery and Oncology, O'Brien Institute for Public Health and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Room 3D41, Calgary, AB, T2N 4Z6, Canada. kmsauro@ucalgary.ca.
无家可归的重症患者在重症监护室 (ICU) 入院后使用更高的医疗保健,包括在30天内更多的急诊室访问和医院再入院. 这些发现强调了需要有针对性的排放战略来减少资源利用.
科学领域:
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 无家可归是健康的重要社会决定因素,影响了获得和利用医疗保健服务.
- 危急病患者代表一个有复杂需求的弱势群体,住房状况可能进一步影响他们的结果和资源使用.
- 了解重症监护室 (ICU) 中无家可归者的特定医疗护理轨迹对于开发公平护理模型至关重要.
研究的目的:
- 为了比较无家可归的危急病患者的流行病学和医疗保健资源利用情况,与有稳定的住房的人相比.
- 为了确定这两个患者群体之间的护理过程,停留时间,再接收率和急诊室访问的差异.
- 为旨在优化无家可归人口的ICU后护理的战略提供信息.
主要方法:
- 在加拿大阿尔伯塔省进行了一项以人口为基础的回顾性队列研究,使用了加拿大阿尔伯塔省成人ICU入院的行政和临床数据,持续了三年.
- 检查了医疗保健资源的使用情况,包括护理流程,ICU和住院时间,医院再入院和急诊室的访问.
- 用回归分析来量化基于住房状况的医疗保健利用率差异.
主要成果:
- 2.3%的ICU患者无家可归;他们年轻,更经常出于医疗原因入院,并比住院患者有较少的并发症.
- 虽然ICU护理流程类似,但无家可归的幸存者30天访问急诊室的可能性是30倍以上 (OR=2.3) 或重新入院 (OR=2.1).
- 无家可归的患者在ICU出院后的住院时间比稳定住房的患者长10.1天.
结论:
- 无家可归的重症患者在ICU入院时表现出不同的人口和临床特征.
- 尽管有类似的ICU护理,但无家可归患者在出院后的医疗保健资源利用率显著提高,包括急诊和再入院的增加.
- 调查结果强调了针对无家可归者进行量身定制的出院规划和ICU后支持的必要性,以减轻长时间的医疗参与并改善结果.
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