患者报告的结果可预测卒中患者未来的急诊就诊和住院,Journal of the American Heart Association

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患者报告的结果可预测卒中患者未来的急诊就诊和住院
Journal of the American Heart Association ( IF 5.4 ) Pub Date : 2021-03-05 , DOI: 10.1161/jaha.120.018794
Irene L Katzan _{1,

2} , Nicolas Thompson ₁ , Andrew Schuster ₁ , Dolora Wisco ₂ , Brittany Lapin ₁

Affiliation

背景识别急诊科 (ED) 就诊或住院风险增加的中风患者可以实施缓解策略。我们评估了作为常规护理的一部分收集的患者报告结果信息测量系统 (PROMIS) 患者报告结果 (PRO) 在添加到其他现成的临床变量时预测 1 年急诊科 (ED) 就诊和入院的能力.方法和结果这是一项队列研究，纳入了 2015 年 2 月 17 日至 2018 年 6 月 11 日在脑血管门诊就诊的 1696 名缺血性卒中、脑出血、蛛网膜下腔出血或短暂性脑缺血发作患者，他们在就诊时完成了以下 PRO ：患者健康问卷 9，神经疾病认知功能的生活质量，PROMIS 全球健康，睡眠障碍、疲劳、焦虑、社会角色满意度、身体机能、疼痛干扰。构建了一系列逻辑回归模型来确定包括 PRO 评分在内的模型预测 1 年 ED 就诊以及全因和非计划入院的能力。在 PRO 就诊日期后的 1 年内，548 名患者发生了 1046 次 ED 就诊；453 名患者中发生了 751 次入院。除 PROMIS 睡眠外，所有 PRO 均与未来的 ED 就诊和入院显着相关。预测意外入院的模型具有最高的乐观校正曲线下面积（范围，0.684-0.724），其次是急诊就诊（范围，0.674-0.691），然后是全因入院（范围，0.628-0.671）。测量心理健康领域的 PRO 与 ED 就诊有更强的关联；测量身体健康领域的 PRO 与入院有更强的关联。结论 PROMIS 量表提高了预测卒中患者就诊和入院的能力。模型性能的差异和预测模型中最具影响力的 PRO 表明影响未来住院和急诊就诊的因素存在差异。

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Patient‐Reported Outcomes Predict Future Emergency Department Visits and Hospital Admissions in Patients With Stroke

BackgroundIdentification of stroke patients at increased risk of emergency department (ED) visits or hospital admissions allows implementation of mitigation strategies. We evaluated the ability of the Patient‐Reported Outcomes Information Measurement System (PROMIS) patient‐reported outcomes (PROs) collected as part of routine care to predict 1‐year emergency department (ED) visits and admissions when added to other readily available clinical variables.Methods and ResultsThis was a cohort study of 1696 patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack seen in a cerebrovascular clinic from February 17, 2015, to June 11, 2018, who completed the following PROs at the visit: Patient Health Questionnaire‐9, Quality of Life in Neurological Disorders cognitive function, PROMIS Global Health, sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. A series of logistic regression models was constructed to determine the ability of models that include PRO scores to predict 1‐year ED visits and all‐cause and unplanned admissions. In the 1 year following the PRO encounter date, 1046 ED visits occurred in 548 patients; 751 admissions occurred in 453 patients. All PROs were significantly associated with future ED visits and admissions except PROMIS sleep. Models predicting unplanned admissions had highest optimism‐corrected area under the curve (range, 0.684–0.724), followed by ED visits (range, 0.674–0.691) and then all‐cause admissions (range, 0.628–0.671). PROs measuring domains of mental health had stronger associations with ED visits; PROs measuring domains of physical health had stronger associations with admissions.ConclusionsPROMIS scales improve the ability to predict ED visits and admissions in patients with stroke. The differences in model performance and the most influential PROs in the prediction models suggest differences in factors influencing future hospital admissions and ED visits.

更新日期：2021-03-16

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