背景:这项研究评估了有针对性的基于电话的病例管理服务的有效性,该服务旨在减少频繁就诊者的ED出勤率,众所周知,不成比例地促进了需求。关于这些服务有效性的证据各不相同。
方法:一项为期24个月的前后对照研究,根据808例患者(128例和680例对照(41例非依从)),他们在英国急诊科手术的前4个月接受了服务.通过预测模型对6个月内再次就诊的高风险患者进行手动筛选。那些积极评价的人被提供了非临床,护士主导,基于电话的健康指导,包括护理计划,协调和目标设定长达9个月。使用差异差异(DiD)分析来估计服务有效性。比较了ED和轻伤单位(MIU)出勤率以及在接受ED出勤率后12个月内干预接受者和对照组的平均住院时间。调整前12个月期间,性别和年龄,给出发病率比率(IRR)。
结果:干预接受者更可能是女性(63.3%对55.4%),年轻(平均69岁对76岁),并且ED活性水平(MIU除外)高于对照组。所有结果(MIU出勤除外)的平均比率在不同时期之间下降。意向治疗分析表明,干预措施在降低所有结局方面的效果无统计学意义。除了MIU的出勤率,IRR:ED出勤率,0.856(95%CI:0.631,1.160);ED招生,0.871(95%CI:0.628,1.208);急诊和择期入院的住院时间:0.844(95%CI:0.619,1.151)和0.781(95%CI:0.420,1.454)。MIU出勤率增加,内部收益率:2.638(95%CI:1.041,6.680)。
结论:基于电话的健康指导似乎可以有效减少ED的出勤率和入院率,停留时间较短,干预接受者对控制的影响。未来的研究需要捕获急性活动以外的结果,更好地理解这样的服务是如何提供附加值的。
BACKGROUND: This study evaluates the effectiveness of a targeted telephone-based
case management service that aimed to reduce ED attendance amongst frequent attenders, known to disproportionately contribute to demand. Evidence on the effectiveness of these services varies.
METHODS: A 24-month controlled before-and-after study, following 808 patients (128 cases and 680 controls (41 were non-compliant)) who were offered the service in the first four months of operation within a UK ED department. Patients stratified as high-risk of reattending ED within 6 months by a predictive model were manually screened. Those positively reviewed were offered a non-clinical, nurse-led, telephone-based health coaching, consisting of care planning, coordination and goal setting for up to 9 months. Service effectiveness was estimated using a difference-in-differences (DiD) analysis. Incident rate of ED and Minor Injury Unit (MIU) attendances and average length of stay in intervention recipients and controls over 12 months after receiving their service offer following ED attendance were compared, adjusting for the prior 12-month period, sex and age, to give an incidence rate ratio (IRR).
RESULTS: Intervention recipients were more likely to be female (63.3% versus 55.4%), younger (mean of 69 years versus 76 years), and have higher levels of ED activity (except for MIU) than controls. Mean rates fell between periods for all outcomes (except for MIU attendance). The Intention-to-Treat analysis indicated non-statistically significant effect of the intervention in reducing all outcomes, except for MIU attendances, with IRRs: ED attendances, 0.856 (95% CI: 0.631, 1.160); ED admissions, 0.871 (95% CI: 0.628, 1.208); length of stay for emergency and elective admissions: 0.844 (95% CI: 0.619, 1.151) and 0.781 (95% CI: 0.420, 1.454). MIU attendance increased with an IRR: 2.638 (95% CI: 1.041, 6.680).
CONCLUSIONS: Telephone-based health coaching appears to be effective in reducing ED attendances and admissions, with shorter lengths of stay, in intervention recipients over controls. Future studies need to capture outcomes beyond acute activity, and better understand how services like this provide added value.