坎登联盟护理管理计划改善了中间护理协调:一个随机对照试验
Amy Finkelstein1, Joel C Cantor2, Jesse Gubb3
1Amy Finkelstein (afink@mit.edu), Massachusetts Institute of Technology, Cambridge, Massachusetts.
护理管理计划可能不会减少急需患者的住院再接收. 密切护理协调增加了门诊访问,但没有显著影响整体再入院率,这表明这种方法存在局限性.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
背景情况:
- 对高使用,高需要患者的护理管理计划的随机评估,在医院再入院方面产生了零结果.
- 无效结果的解释包括有缺陷的程序理论或实现失败.
- 了解这些因素对于改善医疗保健干预至关重要.
研究的目的:
- 调查为什么一个著名的护理管理计划没有减少医院再入院.
- 要区分缺乏程序有效性和实施忠实性问题.
- 评估该计划对促进退院后门诊护理的影响.
主要方法:
- 将研究参与者与70%的原始队列的医疗补助数据联系起来.
- 检查了该计划对促进出院后的门诊护理的影响,这是护理协调的关键组成部分.
- 分析数据以确定对患者结果和医疗保健利用的影响.
主要成果:
- 护理管理计划在出院后的14天内显著增加了15个百分点的门诊访问.
- 门诊护理的增加,特别是初级保健,持续了365天.
- 尽管门诊护理增加了,但该计划并没有证明医院再入院的减少.
结论:
- 仅仅是护理协调可能不足以减少复杂,高需求的患者群体的住院再诊.
- 实施忠实度至关重要,但即使增加了门诊护理,也没有实现重新入院的减少.
- 需要进一步的研究来确定这种患者群的有效策略.
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