背景:新的CMS法规要求在住院期间进行社会风险筛查,但其对住院护理和患者预后的影响尚不清楚.
目的:评估实施社会风险筛查方案是否能改善出院流程,患者报告的结果,和30天的服务使用。
方法:务实混合方法临床试验。
方法:总的来说,在美国Intermountain的528张病床的学术医疗中心和15名主治医师中,4130名患者从普通医学和外科服务中出院(2383名实施前和1747名实施后)。
方法:记录家庭互动,延迟出院,患者报告的出院准备和出院后应对困难,出院后30天内再入院和急诊室就诊,以及对住院医生的编码采访。
结果:多变量分段回归模型表明,干预实施后家庭互动的几率每月降低19%(OR=0.81,95%CI=0.76-0.86,P<0.001),另一个模型发现下午2点后出院的几率降低了32%(OR=0.68,95%CI=0.53-0.87,P=0.003).在患者报告的出院准备中,没有充血后的变化,出院后应对困难,或者再入院30天,或ED访问。医生对适当性表示担忧,可接受性,结构化社会风险评估的可行性。
结论:在COVID后的即时时间范围内进行,减少家庭互动,较早的放电,和提供者对结构化社会风险评估的担忧可能导致缺乏干预对患者结局的影响.为了有效,社会风险筛查将需要患者/家庭和护理团队共同设计其结构和流程,和分配资源,以协助解决已确定的社会风险需求。
BACKGROUND: Social risk screening during inpatient care is required in new CMS regulations, yet its impact on inpatient care and patient outcomes is unknown.
OBJECTIVE: To evaluate whether implementing a social risk screening protocol improves discharge processes, patient-reported outcomes, and 30-day service use.
METHODS: Pragmatic mixed-methods clinical trial.
METHODS: Overall, 4130 patient discharges (2383 preimplementation and 1747 postimplementation) from general medicine and surgical services at a 528-bed academic medical center in the Intermountain United States and 15 attending physicians.
METHODS: Documented family interaction, late discharge, patient-reported readiness for hospital discharge and postdischarge coping difficulties, readmission and emergency department visits within 30 days postdischarge, and coded interviews with inpatient physicians.
RESULTS: A multivariable segmented regression model indicated a 19% decrease per month in odds of family interaction following intervention implementation (OR=0.81, 95% CI=0.76-0.86, P<0.001), and an additional model found a 32% decrease in odds of being discharged after 2 pm (OR=0.68, 95% CI=0.53-0.87, P=0.003). There were no postimplementation changes in patient-reported discharge readiness, postdischarge coping difficulties, or 30-day hospital readmissions, or ED visits. Physicians expressed concerns about the appropriateness, acceptability, and feasibility of the structured social risk assessment.
CONCLUSIONS: Conducted in the immediate post-COVID timeframe, reduction in family interaction, earlier discharge, and provider concerns with structured social risk assessments likely contributed to the lack of intervention impact on patient outcomes. To be effective, social risk screening will require patient/family and care team codesign its structure and processes, and allocation of resources to assist in addressing identified social risk needs.