發(fā)布時(shí)間：2019-02-14 20:51

【摘要】：背景心力衰竭患者出院后,醫(yī)生做早期隨訪與死亡和再住院率下降相關(guān),此研究探討了醫(yī)生的連續(xù)性是否會(huì)進(jìn)一步影響患者出院后的轉(zhuǎn)歸。方法數(shù)據(jù)源于數(shù)據(jù)庫,將加拿大艾伯塔省1999年1月—2009年6月,年滿20周歲首次診斷為心力衰竭的,且出院時(shí)還活著的患者納入研究。采用協(xié)變量隨時(shí)間變化的Cox比例風(fēng)險(xiǎn)模型,就患者熟悉的醫(yī)生在患者出院后1個(gè)月內(nèi)做隨訪,其對(duì)6個(gè)月內(nèi)患者發(fā)生死亡或任何原因急診再入院等主要轉(zhuǎn)歸的影響進(jìn)行分析。患者熟悉的醫(yī)生定義:患者入院前1年至少看過患者2次,或患者住院期間看過患者至少1次的醫(yī)生。結(jié)果出院后1個(gè)月,24 373例患者中,有5 336例(21.9%)患者未接受過隨訪,16 855(69.2%)例患者接受了熟悉醫(yī)生的隨訪,2 182(9.0%)例接受陌生醫(yī)生的隨訪。6個(gè)月觀察期內(nèi),與未接受過隨訪的患者(62.9%)相比,接受熟悉醫(yī)生早期隨訪的患者〔43.6%;校正危險(xiǎn)比(HR)=0.87,95%CI(0.83,0.91)〕或接受陌生醫(yī)生早期隨訪的患者〔43.6%;校正HR=0.90,95%CI(0.83,0.97)〕發(fā)生死亡或非計(jì)劃入院的風(fēng)險(xiǎn)性要低。將接受隨訪時(shí)間超過6個(gè)月的患者也納入分析,與接受陌生醫(yī)生隨訪相比,由熟悉醫(yī)生做隨訪,患者發(fā)生死亡和急診再住院的風(fēng)險(xiǎn)要低〔校正HR=0.91,95%CI(0.85,0.98)〕。解釋心力衰竭患者出院后,醫(yī)生的早期隨訪及醫(yī)生的連續(xù)性,均與患者獲得較好的臨床轉(zhuǎn)歸相關(guān)。在其他疾病及其他環(huán)境下,醫(yī)生的連續(xù)性是否也起到重要作用還需做進(jìn)一步研究。
[Abstract]:Background early follow-up of patients with heart failure after discharge is associated with a decrease in mortality and readmission. This study was conducted to investigate whether the continuity of doctors may further affect the outcome of discharged patients. Methods data derived from the database included patients who were first diagnosed with heart failure at the age of 20 and were still alive at the time of discharge from January 1999 to June 2009 in Alberta Canada. By using the Cox proportional risk model with covariable variation over time, the main outcomes of the patients' death or readmission for any reason were analyzed during the first month after discharge from hospital by the familiar doctors. A doctor who sees a patient at least twice a year before admission, or at least once during hospitalization. Results one month after discharge, 5 336 (21. 9%) of 24 373 patients were not followed up, 16 855 (69. 2%) were followed up by familiar doctors. 2182 (9.0%) patients were followed up by strange doctors. During the 6-month observation period, compared with the patients who had not been followed up (62.9%), the patients who were familiar with the doctor's early follow-up (43.6%) were compared with those who had not been followed up (62.9%). The corrected risk was lower than the risk of death or unplanned admission in patients with (HR) = 0.87% 95 CI (0.83 鹵0.91) or early follow-up by a strange doctor (43.6; adjusted HR=0.90,95%CI (0.830.97). Patients who were followed up for more than 6 months were also included in the analysis. The risk of death and readmission of emergency patients was lower than that of unfamiliar doctors (adjusted HR=0.91,95%CI (0.850.98). It was explained that the early follow-up and continuity were related to the clinical outcome of patients with heart failure. In other diseases and other settings, whether the continuity of doctors also plays an important role needs to be further studied.
【作者單位】： 中國石油天然氣集團(tuán)公司中心醫(yī)院;
【分類號(hào)】：R541.6

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