对死亡率和逗留时间的分析与在综合医疗保健系统中实施大型远程临床护理计划相关
Michael Guarnieri1, Patricia Kipnis2, Ashil Panchal1
1Department of Critical Care Medicine, Kaiser Permanente, Oakland, CA.
Critical care medicine
|October 30, 2025
概括
远程临床护理 (TCC) 计划可以减少住院患者的死亡率. 这项研究发现,TCC的实施与较低的调整后死亡风险有关,尽管停留时间没有显著变化.
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
- 远程医疗服务是远程医疗服务.
背景情况:
- 远程临床护理 (TCC) 计划与患者的治疗结果有着不同的关联.
- 之前的研究表明,通过TCC的实施,可能会降低死亡率和停留时间 (LOS).
- 在TCC结果的异质性需要进一步调查患者敏度和并发症等因素.
研究的目的:
- 评估TCC计划对住院患者死亡率和住院时间 (LOS) 的影响.
- 根据急性疾病严重程度和慢性并发症来检查结果异质性.
- 评估在综合医疗保健系统中一夜之间实施TCC计划的影响.
主要方法:
- 从2015年1月到2024年4月对成年ICU患者的回顾性研究.
- 172,878例患者接触的比较 (TCC前与TCC后的实施).
- 用于估计死亡率和LOS差异的调整相对风险 (ARR) 的通用线性模型.
主要成果:
- 在调整后,TCC暴露与住院患者死亡率降低有关 (ARR 0.93;95% CI,0.89-0.98).
- 未经调整的分析显示,TCC组的死亡率更高,度和COVID-19率更高.
- 经死亡率调整的ICU和医院LOS在TCC暴露和未暴露组之间没有显示统计学上显著的差异.
结论:
- 通过TCC计划实现夜间覆盖的多医院实施降低了住院患者死亡率的调整风险.
- 在死亡率调整后的ICU或医院LOS中没有发现显著差异.
- 通过TCC计划可以提供死亡福利,而不会显著改变患者逗留时间.
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