医院因素与急诊整体外科的护理碎片化有关:持续性较低,死亡率较高
Vahe S Panossian1, May Abiad1, Christine J Atallah2
1From the Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Panossian, Abiad, Nzenwa, Lal, Mazraany, Ng-Kamstra, Hwabejire, Kaafarani, DeWane).
Journal of the American College of Surgeons
|June 2, 2025
概括
在紧急整体外科 (EGS) 患者的护理碎片化 (FOC) 与更高的死亡率有关. 医院的大小和所有权等因素影响FOC,强调需要改善护理协调.
科学领域:
- 手术护理 手术护理
- 医疗保健服务研究 医疗服务研究
- 患者的治疗结果.
背景情况:
- 护理碎片化 (FOC),定义为重新入院到非指数医院,是紧急整体外科 (EGS) 的一个问题.
- 在EGS患者中,FOC可能与不良结果有关.
- 了解与FOC模式相关的医院特征至关重要.
研究的目的:
- 评估与EGS患者的FOC模式相关的医院特征.
- 评估FOC后的设施间转移对死亡率的影响.
- 确定导致EGS医疗服务分散的因素.
主要方法:
- 对2019年全国再接收数据库对18岁以上EGS患者的分析.
- 将患者分为四种FOC模式:没有FOC,FOC,分散和超分散的护理.
- 多变量后勤回归以确定与FOC相关的医院特征及其对90天死亡率的影响,控制患者严重程度 (APR-DRG).
主要成果:
- 在26100名EGS患者中,有16.4%的患者经历了FOC.
- FOC与较小的医院规模,私人/政府所有权和较低的EGS数量有关.
- FOC显著增加了90天死亡率 (OR 1.22),特别是在疾病严重程度高的患者 (OR 1.36) 中.
结论:
- 护理的碎片化与EGS患者的更糟糕结果有显著的关联.
- 医院的特点在观察到的FOC模式中起作用.
- 需要对EGS护理系统进行进一步研究,以减轻FOC的负面影响.
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