https://scholars.lib.ntu.edu.tw/handle/123456789/512494
標題: | Integrated postdischarge transitional care in a hospitalist system to improve discharge outcome: An experimental study | 作者: | CHIN-CHUNG SHU NIN-CHIEH HSU YU-FENG LIN JANN-YUAN WANG JOU-WEI LIN Ko W.-J. |
公開日期: | 2011 | 卷: | 9 | 起(迄)頁: | 96 | 來源出版物: | BMC Medicine | 摘要: | Background: The postdischarge period is a vulnerable time for patients, with high rates of adverse events that may cause unnecessary readmissions, especially in the elderly. Because postdischarge care continuity is often interrupted after hospitalist care, close follow-up may decrease patient readmission. In this study, we aimed to investigate the impact of a quality improvement program, integrated postdischarge transitional care (PDTC), in Taiwan's hospitalist system.Methods: From December 2009 to May 2010, patients admitted to the hospitalist ward of a medical center in Taiwan and later discharged alive to home care were included. Efforts to improve the quality of interventions in the PDTC program, including a disease-specific care plan, telephone monitoring, hotline counseling and referral to a hospitalist-run clinic, were implemented in the latter four months in the intervention group, while the control group was recruited during the first two months of the study period. The primary end point was unplanned readmission or death within 30 days after discharge.Results: There were 94 and 219 patients in the control and intervention groups, respectively. Both groups had similar characteristics at the time of admission and at discharge. In the intervention group, 18 patients with worsening disease-specific indicators recorded during telephone monitoring and 21 patients with new or worsening symptoms recorded during hotline counseling had higher rates of unplanned readmission than those without worsening disease-specific indicators (P = 0.031) and worsening symptoms (P = 0.019), respectively. Patients who received PDTC had lower rates of readmission and death than the control group within 30 days after discharge (15% vs. 25%; P = 0.021). Nonuse of a hospitalist-run clinic and presence of underlying malignancy were other independent risk factors for readmission and death within 30 days after discharge.Conclusion: Integrated PDTC using disease-specific care, telephone monitoring, hotline counseling and a hospitalist-run clinic can reduce rates of postdischarge readmission and death. ? 2011 Shu et al; licensee BioMed Central Ltd. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-80051655735&doi=10.1186%2f1741-7015-9-96&partnerID=40&md5=8647b8216aea8101a99d343173fe803c https://scholars.lib.ntu.edu.tw/handle/123456789/512494 |
ISSN: | 1741-7015 | DOI: | 10.1186/1741-7015-9-96 | SDG/關鍵字: | adult; aged; article; controlled study; experimental study; female; health care; health care delivery; health care planning; health care quality; health care system; home care; hospital discharge; hospital readmission; human; major clinical study; male; mortality; patient monitoring; postdischarge transitional care; Taiwan; telemedicine; ambulatory care; counseling; hospital; hospital discharge; methodology; middle aged; patient care; prospective study; statistics; survival; treatment outcome; Aged; Aged, 80 and over; Ambulatory Care; Counseling; Female; Home Care Services; Hospitals; Humans; Male; Middle Aged; Patient Care; Patient Discharge; Patient Readmission; Prospective Studies; Survival Analysis; Taiwan; Treatment Outcome |
顯示於: | 醫學系 |
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