探索急性中风住院后失去随访的关键风险因素
Benjamin R Kummer1, Soonmyung A Hwang2, Parul Agarwal3
1Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Clinical Neuro-Informatics Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
概括
超过三分之一的急性中风患者在出院一年内失去了随访 (LTFU). 预测LTFU的因素包括自我支付状态和急性护理设施的出院,突出干预的领域.
科学领域:
- 神经学 神经学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 有相当数量的中风幸存者在出院后经历了跟踪损失 (LTFU).
- LTFU可能会增加不良健康结果的风险,包括死亡率和再住院.
研究的目的:
- 为了确定急性中风患者退院后LTFU的关键预测因素.
- 为改善对中风幸存者的护理连续性的策略提供信息.
主要方法:
- 从2016年1月到2020年12月,对2597名急性中风患者进行了回顾性分析.
- 使用了美国心脏协会的"了解指南"注册表.
- 采用LASSO进行变量选择和逻辑回归以模型LTFU预测器.
主要成果:
- 33.8%的患者在12个月内进行了LTFU. 与LTFU增加相关的因素包括男性性别,脑内出血,出院到熟练护理机构,以及更高的修改的兰金尺度 (mRS) 分数.
- 调整后的分析显示,自我支付状态 (aOR 3.8),急性护理出院 (aOR 5.3) 和mRS 5 (aOR 2.4) 显著增加了LTFU的几率.
- 医疗保险覆盖率 (aOR 0.60),住院康复退院率 (aOR 0.54),以及家族中风病史 (aOR 0.37) 与LTFU几率降低有关.
结论:
- 确定了与中风患者的LTFU相关的特定临床特征和出院目的地.
- 调查结果强调需要有针对性的干预措施,以改善后续护理和降低LTFU率.
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