我们研究了哪些居民级别的临床因素会影响养老院(NHs)最近的医疗服务。
多点横截面。
我们从安大略省的18个NH设施中提取了3,556个NH居民的数据,加拿大,谁至少收到了,2009年11月1日至2017年10月31日期间使用居民评估仪器最低数据集(MDS)2.0进行的入院和第一季度评估。
我们对常规收集的MDS2.0数据进行了二次分析。在居民的第一季度MDS2.0评估之前的14天内,评估了医生(或授权的临床医生)最近的医疗护理访问。我们利用最佳子集多变量逻辑回归对居民水平临床因素与最近一次医疗就诊之间的校正关联进行建模。
两千八百五十九(80.4%)NH居民在第一季度MDS2.0评估之前有一次或多次医疗护理访问。在最终模型中,六个临床相关因素被确定为与最近的医疗护理访问相关:表现出流浪行为(OR=1.34,95%CI1.09-1.63),存在压疮(OR=1.37,95%CI1.05-1.78),尿路感染(UTI)(OR=1.52,95%CI1.06-2.18),终末期疾病(OR=9.70,95%CI1.32-71.02),新药使用(OR=1.31,95%CI1.09-1.57),和镇痛药使用(OR=1.24,95%CI1.03-1.49)。
我们的研究结果表明,居民水平的临床因素推动了NH入院后医疗护理的提供。与医疗护理访问相关的临床因素与NH实践中医生期望的最低能力一致,包括管理安全风险,感染,药物,和死亡。确保NH医生有机会获得和加强这些能力可能是变革性的,以满足NH居民的持续需求。
We examined which resident-level clinical factors influence the provision of a recent medical care visit in nursing homes (NHs).
Multi-site cross-sectional.
We extracted data on 3,556 NH residents from 18 NH facilities in Ontario, Canada, who received at minimum, an admission and first-quarterly assessment with the Resident Assessment Instrument Minimum Data Set (MDS) 2.0 between November 1, 2009, and October 31, 2017.
We conducted a secondary analysis of routinely collected MDS 2.0 data. The provision of a recent medical care visit by a physician (or authorized clinician) was assessed in the 14-day period preceding a resident\'s first-quarterly MDS 2.0 assessment. We utilized best-subset multivariable logistic regression to model the adjusted associations between resident-level clinical factors and a recent medical care visit.
Two thousand eight hundred fifty nine (80.4%) NH residents had one or more medical care visits prior to their first-quarterly MDS 2.0 assessment. Six clinically relevant factors were identified to be associated with recent medical care visits in the final model: exhibiting wandering behaviours (OR = 1.34, 95% CI 1.09 - 1.63), presence of a pressure ulcer (OR = 1.37, 95% CI 1.05 - 1.78), a urinary tract infection (UTI) (OR = 1.52, 95% CI 1.06 - 2.18), end-stage disease (OR = 9.70, 95% CI 1.32 - 71.02), new medication use (OR = 1.31, 95% CI 1.09 - 1.57), and analgesic use (OR = 1.24, 95% CI 1.03 - 1.49).
Our findings suggest that resident-level clinical factors drive the provision of medical care visits following NH admission. Clinical factors associated with medical care visits align with the minimum competencies expected of physicians in NH practice, including managing safety risks, infections, medications, and death. Ensuring that NH physicians have opportunities to acquire and strengthen these competencies may be transformative to meet the ongoing needs of NH residents.