出院准备服务需求程度对老年慢性心力衰竭患者住院时间的影响

The impact of discharge planning demand score for length of stay in older patients with chronic heart failure

目的评价出院准备服务需求程度评分对老年慢性心力衰竭患者住院时间延长的预测作用,并分析相应护理对策。方法采用便利抽样法,于2021年11月—2022年6月收集北京市某三级甲等医院心内科病房老年患者的一般资料、出院准备服务需求程度评分及住院时间,按照住院时间分为住院时间延长组(>7 d)和非延长组(≤7 d),采用Logistic回归分析探讨老年慢性心力衰竭患者住院时间延长的独立影响因素,并采用受试者操作特征曲线评价出院准备服务需求程度对住院时间延长的预测价值。结果共纳入老年慢性心力衰竭患者343例,其中住院时间延长组136例、住院时间非延长组207例。Logistic回归分析显示,独居(OR=2.721,P=0.027)、出院准备服务需求程度评分高(OR=1.503,P<0.001)是老年慢性心力衰竭患者住院时间延长的独立危险因素。出院准备服务需求程度评分对老年慢性心力衰竭患者住院时间延长预测的受试者操作特征曲线下面积为0.828(95%CI为0.781~0.876,P<0.001),最佳临界值为3.5分,对应的灵敏度为70.6%,特异度为85.5%。结论出院准备服务需求程度评分对于老年慢性心力衰竭患者住院时间延长具有良好预测价值,可用于住院时间延长高危个体的早期识别。

Objective To evaluate the value of discharge planning demand score for prediction of prolonged length of stay in older patients with chronic heart failure,and analyze corresponding nursing strategies.Methods From November 2021 to June 2022,343 older patients with chronic heart failure admitted to the cardiology wards of a tertiary hospital in Beijing were recruited,and the general data,the score of discharge planning demand and the length of stay were collected.We divided the patients into 2 groups according to the length of stay.Binary logistic regression analysis was used to explore the influencing factors of prolonged length of stay.Predictive value of discharge planning demand score for prolonged length of stay was assessed by receiver operating curve(ROC)analysis.Results There were 343 older patients with chronic heart failure included in this study.Length of stay was prolonged in 136 cases(>7 d).The results of binary logistic regression analysis showed that living alone(OR=2.721,P=0.027)and the discharge planning demand score(OR=1.503,P<0.001)were independent predictors for pro-longed length of stay.The area under the ROC curve was 0.828(95%CI 0.781~0.876,P<0.001);the optimal critical value was 3.5,and the corresponding sensitivity was 70.6%and the specificity was 85.5%.Conclusion The discharge planning demand score has good predictive value for the prolonged length of stay in older patients with chronic heart failure,so as to be used for early identification of high-risk individuals with prolonged length of stay.