出院小结质量高 可减少心衰再入院

  根据耶鲁大学医学院的两项最新研究，心力衰竭患者在出院回家的过渡期间，如果患者能从主治医师那里得到及时且含有全面有用信息的出院小结可使其较快恢复并可减少心衰再入院率。相关研究发表于《循环:心血管质量与转归》(Circulation: Cardiovascular Quality and Outcomes)杂志。

  主要研究者耶鲁大学医学院内科副教授Leora Horwitz博士表示，理论上，出院小结是让内科医生以外的人理解患者在住院期间进行了怎么样的诊治，但实际上它充当了医学账单，医生们并未充分应用出院小结。为确保患者出院后更为安全，出院小结应包括三项主要因素：必须及时，有效发送给外面的内科医生，包含有用信息。

  研究者分析了来自46所医院的1500余项出院小结。在第一项研究中，研究者们分析的预期所有医院的出院小结都相似，但他们发现在执行方面这些医院非常不同。即使在执行力最强的医院里，出院小结在及时性、发送和内容方面的质量也不够。没有医院在所有领域一贯地做出高质量的出院小结。

  在第二项研究中，研究者们利用了同样的数据来观察医院出院小结的执行改善在患者再入院方面是否有不同。结果显示，出院小结的质量确实和再入院风险有相关性，即出院小结包含有用内容或传达给外部医生的那些患者再入院率较低。研究者表示，该研究首次证明，确实值得花费一些时间和精力在改善出院交流上了。

  原文：

  When used effectively, discharge summaries reduce hospital readmissions

  For heart failure patients making the transition from hospital to home, a discharge summary that gets to their primary doctors quickly and contains detailed and useful information can mean the difference between recovering quickly or returning to the hospital, according to two new studies from Yale School of Medicine researchers.

  The findings are published by the Yale research team in the current issue of Circulation: Cardiovascular Quality and Outcomes.

  In theory, a discharge summary is meant to help outside physicians understand what happened to patients while they were hospitalized, but in practice, it has served as an aid for medical billing, according to lead author Dr. Leora Horwitz, adjunct associate professor of internal medicine at Yale School of Medicine and director of the Center for Healthcare Innovation and Delivery Science at New York University Langone Medical Center. “The medical community hasn’t really made full use of discharge summaries as a tool for transitions,” she said.

  Horwitz and her team analyzed data from Telemonitoring to Improve Heart Failure Outcomes (Tele-HF), a large multicenter study of patients hospitalized with heart failure. This data contained more than 1,500 discharge summaries from 46 hospitals across the country. Horwitz said in order for a discharge summary to do the job of making the transition from hospital to home safer, it needs three key factors: It has to be timely, it has to be sent to the outside physician, and it has to include useful information. “It’s like a three-legged stool,” she said. “All three need to be present in order for it to do its job.”

  In the first study, Horwitz and her team expected the summaries to be similar at all the hospitals they analyzed, but they found that hospitals varied widely in their performance. And even at the highest-performing hospitals, the quality of discharge summaries was insufficient in terms of timeliness, transmission, and content. No hospital consistently produced high-quality summaries in all domains.

  In the second study using the same data from Tele-HF, the team looked at whether improving hospital practices regarding discharge summaries made a difference in hospital readmissions. They found that discharge summary quality was indeed associated with readmission risk; patients whose summaries included useful content or were sent to outside clinicians had lower readmission rates.

  “This study tells us for the first time that it is actually worth spending the time and effort to improve discharge communication, and patients do seem to benefit,” said Horwitz.

  Other authors on the two studies include first author Dr. Mohammed Salim Al-Damluji; Kristina Dzara; Beth Hodshon; Dr. Natdanai Punnanithinont; Dr. Harlan M. Krumholz; and Dr. Sarwat I. Chaudhry.

  The studies were funded in part by the National Heart, Lung, and Blood Institute; The National Institute on Aging; the American Federation for Aging Research through the Paul B. Beeson Career Development Awards in Aging Research Program; and the Center for Cardiovascular Outcomes Research at Yale. Horwitz is also a recipient of the Clinical and Translational Science Award from Yale Center for Clinical Investigation.