复诊,再入院和死亡率从紧急部门的入院老年人与模糊的演示:纵向观察研究
Sebastian Alejandro Alvarez Avendano1, Amy Cochran2, Valerie Odeh Couvertier1
1Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, 3107 Mechanical Engineering Building, 1513 University Avenue, Madison, WI, 53706, United States, 1 (608) 262-2686.
老年人进入急诊室 (ED) 的住院可能会增加再入院和死亡风险,特别是那些有虚弱或肺炎的人. 仔细考虑处置决策对于患者的结果至关重要.
科学领域:
- 老年医学 老年医学
- 紧急医疗 紧急医疗
- 医疗保健服务研究 医疗服务研究
背景情况:
- 老年人 (65岁以上) 经常出现在急诊室 (EDs) 里,对住院的需求模糊不清.
- 这种情况可能导致潜在的有害和昂贵的护理,强调需要评估入院与出院的权衡.
- 根据处置决策评估患者的结果对于优化对这一群体的护理至关重要.
研究的目的:
- 量化急诊室 (ED) 处置决定 (入院与出院) 与患者结果之间的关系.
- 分析处置对3,9和30天再访,再接收和死亡率的影响.
- 采用因果推理方法来调整测量和未测量的混因素.
主要方法:
- 一项从2014年1月到2018年9月的ED中3591名老年成人患者的纵向观察研究.
- 包括常见表现的患者:跌倒,虚弱,昏迷,尿路感染,肺炎和细胞炎.
- 利用电子健康记录来追踪ED倾向和9个结果变量在3,9和30天内.
主要成果:
- 入院显著减少了30天的ED复诊 (-6.4%),但显著增加了30天的医院再入院 (5.8%) 和死亡率 (1.0%).
- 入院对虚弱和肺炎的患者尤其有害.
- 入院后的不良影响对于出现跌倒和昏迷的患者来说不那么明显.
结论:
- 对老年人来说,住院并不总是最安全的选择,因为急诊室的表现含糊不清.
- 经常使用的质量指标 - - 重审和再录取,其含义不同,需要谨慎解释.
- 对老年人的处置决定需要仔细考虑个体患者的因素和潜在风险,而不仅仅是简单的再诊或再接收率.
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