背景急性后护理(PAC)中心是用于疗养的设施,康复,和症状管理,以改善患者的长期预后。PAC中心包括熟练的护理设施,住院康复设施,和长期护理医院。在1990年代,医疗保险支付改革显着提高了PAC中心的出院率,随后增加了这些患者人群的住院时间(LOS)。在过去的几年里,有国家倡议和多学科方法来提高安全出院率。多项研究表明,出院回家的患者30天的再入院率降低,降低短期死亡率,以及他们日常生活活动的改善。目的本研究旨在探讨多学科方法如何提高单一机构的出院率。在这样做的时候,我们的目标是降低医院再入院率,住院时间,发病率和死亡率,和医疗保健相关成本。方法在泽西海岸大学医学中心(JSUMC)进行回顾性单机构队列研究。2015年1月至2019年12月的数据作为控制期,与2020年1月至2024年1月的干预期相比。患者要么被JSUMC教学学院录取,住院医生,或“其他”,由各种医学和外科专家组成。为提高家庭出院率而进行的干预可分为以下几类:医生教育,患者教育,电子病历(EMR)计划,问责制,和日常移动计划。所有干预措施在三个患者群体中同等地进行。主要终点是出院患者的比例。结果190,699例患者,分为由98,885名患者组成的干预前组和由91,814名患者组成的干预后组。在干预前小组中,该学院接诊了8,495名患者,住院医生照顾了39145名病人,其他人管理了51,245名患者。在干预后时期,该学院监督了8014名患者,住院医生接诊了35,094名病人,和其他人负责48,706名患者。在实施了一系列多学科干预措施之后,出院患者的比例显着增加,从整个患者人群的74.9%上升到80.2%。具体来说,在教师的照顾下,患者经历了更实质性的改善,放电率从73.6%增加到84.4%。同样,住院医生从69.4%上升到74.3%,其余则从79.3%上升至83.7%。所有观察到的变化产生<0.001的p值。结论通过部署强调医生教育的多方面战略,患者教育,EMR倡议,问责措施,和日常流动性,患者出院回家的比率有统计学显著增加.这些举措被证明具有成本效益,并显著降低了医疗保健相关成本和患者住院时间。需要进一步的研究来研究对医院再入院率以及发病率和死亡率的影响。综合方法展示了其优化患者预后的潜力。
Background Post-acute care (PAC) centers are facilities used for recuperation, rehabilitation, and symptom management in an effort to improve the long-term outcomes of patients. PAC centers include skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals. In the 1990s, Medicare payment reforms significantly increased the discharge rates to PAC centers and subsequently increased the length of stay (LOS) among these patient populations. Over the last several years, there have been national initiatives and multidisciplinary approaches to improve safe discharge rates to home. Multiple studies have shown that patients who are discharged to home have decreased rates of 30-day readmissions, reduced short-term mortality, and an improvement in their activities of daily living. Objectives This study aimed to investigate how multidisciplinary approaches could improve a single institution\'s discharge rates to home. In doing so, we aim to lower hospital readmission rates, hospital length of stay, morbidity and mortality rates, and healthcare-associated costs. Methods A retrospective single-institution cohort study was implemented at Jersey Shore University Medical Center (JSUMC). Data from January 2015 to December 2019 served as the control period, compared to the intervention period from January 2020 to January 2024. Patients were either admitted to JSUMC teaching faculty, hospitalists, or \"others,\" which is composed of various medical and surgical subspecialists. Interventions performed to improve home discharge rates can be categorized into the following: physician education, patient education, electronic medical record (EMR) initiatives, accountability, and daily mobility initiatives. All interventions were performed equally across the three patient populations. The primary endpoint was the proportion of patients discharged to home. Results There were 190,699 patients, divided into a pre-intervention group comprising 98,885 individuals and a post-intervention group comprising 91,814 patients. Within the pre-intervention group, the faculty attended to 8,495 patients, hospitalists cared for 39,145 patients, and others managed 51,245 patients. In the post-intervention period, the faculty oversaw 8,014 patients, hospitalists attended to 35,094 patients, and others were responsible for 48,706 patients. After implementing a series of multidisciplinary interventions, there was a significant increase in the proportion of patients discharged home, rising from 74.9% to 80.2% across the entire patient population. Specifically, patients under the care of the faculty experienced a more substantial improvement, with a discharge rate increasing from 73.6% to 84.4%. Similarly, the hospitalists exhibited a rise from 69.4% to 74.3%, and the others demonstrated an increase from 79.3% to 83.7%. All observed changes yielded a p-value < 0.001. Conclusions By deploying a multifaceted strategy that emphasized physician education, patient education, EMR initiatives, accountability measures, and daily mobility, there was a statistically significant increase in the rate of patient discharges to home. These initiatives proved to be cost-effective and led to a tangible reduction in healthcare-associated costs and patient length of stay. Further studies are required to look into the effect on hospital readmission rates and morbidity and mortality rates. The comprehensive approach showcased its potential to optimize patient outcomes.