PDF(Pubmed)
Abstract：
BACKGROUND: Care transitions are high-risk processes, especially for people with complex or chronic illness. Discharge letters are an opportunity to provide written information to improve patients\' self-management after discharge. The aim of this study is to determine the impact of discharge letter content on unplanned hospital readmissions and self-rated quality of care transitions among patients 60 years of age or older with chronic illness.
METHODS: The study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a \"do not resuscitate\" statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of \"SAFE-D score\". Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission.
RESULTS: All discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.
CONCLUSIONS: While written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge.
BACKGROUND: Clinical Trials. giv, NCT02823795, 01/09/2016.
METHODS: The study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a \"do not resuscitate\" statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of \"SAFE-D score\". Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission.
RESULTS: All discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.
CONCLUSIONS: While written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge.
BACKGROUND: Clinical Trials. giv, NCT02823795, 01/09/2016.
摘要：
背景：护理过渡是高风险的过程，特别是对于患有复杂或慢性疾病的人。出院信函是提供书面信息以改善患者出院后自我管理的机会。这项研究的目的是确定出院信内容对60岁或以上患有慢性病的患者的计划外再入院和自我评估的护理过渡质量的影响。
方法：本研究采用了趋同的混合方法设计。慢性阻塞性肺疾病或充血性心力衰竭患者是从斯德哥尔摩地区的两家医院招募的，如果他们住在家里并且讲瑞典语。痴呆或认知障碍患者，或病历中的“请勿复苏”声明被排除在外。使用评估矩阵和演绎内容分析对招募到随机对照试验的136名患者的出院信进行编码。评估矩阵基于文献综述，以确定出院信函中促进安全护理过渡到家庭的关键要素。编码的关键要素被转换为“SAFE-D评分”的定量变量。计算了SAFE-D评分与护理过渡质量以及30和90天内计划外再入院之间的双变量相关性。最后,多变量Cox比例风险模型用于调查SAFE-D评分与再入院时间之间的关联.
结果：所有出院字母至少包含11个关键要素中的5个。在不到百分之二的出院信件中，所有11个关键要素都出席了。SAFE-D评分都没有,也不是单个关键要素与30天或90天再入院率相关。根据一系列患者特征和自我评估的护理过渡质量进行调整后，SAFE-D评分与再入院时间无关。
结论：虽然书面摘要发挥作用，他们本身可能不足以确保安全的护理过渡和有效的出院后自我护理管理。
背景：临床试验。giv,NCT02823795,01/09/2016。
方法：本研究采用了趋同的混合方法设计。慢性阻塞性肺疾病或充血性心力衰竭患者是从斯德哥尔摩地区的两家医院招募的，如果他们住在家里并且讲瑞典语。痴呆或认知障碍患者，或病历中的“请勿复苏”声明被排除在外。使用评估矩阵和演绎内容分析对招募到随机对照试验的136名患者的出院信进行编码。评估矩阵基于文献综述，以确定出院信函中促进安全护理过渡到家庭的关键要素。编码的关键要素被转换为“SAFE-D评分”的定量变量。计算了SAFE-D评分与护理过渡质量以及30和90天内计划外再入院之间的双变量相关性。最后,多变量Cox比例风险模型用于调查SAFE-D评分与再入院时间之间的关联.
结果：所有出院字母至少包含11个关键要素中的5个。在不到百分之二的出院信件中，所有11个关键要素都出席了。SAFE-D评分都没有,也不是单个关键要素与30天或90天再入院率相关。根据一系列患者特征和自我评估的护理过渡质量进行调整后，SAFE-D评分与再入院时间无关。
结论：虽然书面摘要发挥作用，他们本身可能不足以确保安全的护理过渡和有效的出院后自我护理管理。
背景：临床试验。giv,NCT02823795,01/09/2016。
