背景:儿科重症监护病房(PICU)入院后坚持随访可能是管理PICU后后遗症的关键组成部分。然而,PICU随访依从性的先前工作有限.这项研究的目的是确定住院特征,出院儿童健康指标,和随访特征与由于呼吸衰竭而入院的PICU后在四级护理中心的建议随访和完全依从性相关。
方法:我们对2013年1月12日至2014年12月期间入住四级护理PICU的≤18岁呼吸衰竭患者进行了回顾性队列研究。对四元护理中心出院后两年(2013年1月至2017年3月)的住院后完全依从性和推荐随访进行了量化,并通过人口统计学进行了比较。基线儿童健康指标,住院特征,出院儿童健康指标,以及双变量和多变量分析的随访特征。将患者分为非依从随访(在四级护理中心参加少于100%的推荐预约的患者)和完全依从(在四级护理中心参加100%的推荐预约的患者)。
结果:在出院时存活的155名患者中,140人(90.3%)被建议在四级护理中心进行随访。在四元护理中心推荐随访的140名患者中,32.1%的患者在随访期间未粘附,67.9%的患者完全粘附。在多变量逻辑回归模型中,每次额外推荐的独特随访预约与完全坚持随访的几率较低相关(OR0.74,95%CI0.60-0.91,p=0.005),出院前预约比例每增加10%,与完全坚持随访的机率较高相关(OR1.02,95%CI1.01-1.03,p=0.004).
结论:急性呼吸衰竭入院后,只有三分之二的儿童完全坚持在四级护理中心进行推荐的随访.我们的研究结果表明,将推荐的随访仅限于关键的基本医疗保健提供者,并在出院前尽可能多地安排预约,可以提高随访依从性。然而,需要更好地了解导致不坚持随访预约的因素,以告知更广泛的系统层面方法有助于提高PICU随访依从性.
BACKGROUND: Adherence with follow-up appointments after a pediatric intensive care unit (PICU) admission is likely a key component in managing post-PICU sequalae. However, prior work on PICU follow-up adherence is limited. The objective of this study is to identify hospitalization characteristics, discharge child health metrics, and follow-up characteristics associated with full adherence with recommended follow-up at a quaternary care center after a PICU admission due to respiratory failure.
METHODS: We conducted a retrospective cohort study of patients ≤ 18 years with respiratory failure admitted between 1/2013-12/2014 to a quaternary care PICU. Post-hospitalization full adherence with recommended follow-up in the two years post discharge (1/2013-3/2017) at the quaternary care center was quantified and compared by demographics, baseline child health metrics, hospitalization characteristics, discharge child health metrics, and follow-up characteristics in bivariate and multivariate analyses. Patients were dichotomized into being non-adherent with follow-up (patients who attended less than 100% of recommended appointments at the quaternary care center) and fully adherent (patients who attended 100% of recommended appointments at the quaternary care center).
RESULTS: Of 155 patients alive at hospital discharge, 140 (90.3%) were recommended to follow-up at the quaternary care center. Of the 140 patients with recommended follow-up at the quaternary care center, 32.1% were non-adherent with follow-up and 67.9% were fully adherent. In a multivariable logistic regression model, each additional recommended unique follow-up appointment was associated with lower odds of being fully adherent with follow-up (OR 0.74, 95% CI 0.60-0.91, p = 0.005), and each 10% increase in the proportion of appointments scheduled before discharge was associated with higher odds of being fully adherent with follow-up (OR 1.02, 95% CI 1.01-1.03, p = 0.004).
CONCLUSIONS: After admission for acute respiratory failure, only two-thirds of children were fully adherent with recommended follow-up at a quaternary care center. Our findings suggest that limiting the recommended follow-up to only key essential healthcare providers and working to schedule as many appointments as possible before discharge could improve follow-up adherence. However, a better understanding of the factors that lead to non-adherence with follow-up appointments is needed to inform broader system-level approaches could help improve PICU follow-up adherence.