Contributing factors to the length of stay and discharge destination of home health care patients: 10-year electronic health record analysis using the Donabedian model

IF 1.7 4区医学 Q2 NURSING Japan Journal of Nursing Science Pub Date : 2025-01-21 DOI:10.1111/jjns.12647

Hana Lee, Aeri Kim, Hyeyoun Lee, Kyungmi Woo

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Abstract

Aim

To identify the factors affecting the length of stay (LOS) and discharge destination (DD) of home health care (HHC) patients in South Korea.

Methods

A retrospective cross-sectional study was conducted using the electronic health records of 1769 patients from a hospital in South Korea. Data were collected from January 2013 to December 2022. We categorized the independent variables into patient context, structure, and process factors following a modification of Donabedian's model. Hierarchical and multinomial logistic regression analyses were used.

Results

The mean length of stay was 26.41 days. Patients were discharged to the following locations: 35.0% continued HHC, 21.0% died, 19% were discharged to their homes, 17.0% were admitted, and 8.0% were sent to other locations. Patients' sex, type of insurance coverage, and primary caregiver as well as the number of nurse visits, HHC admission route, and type of nursing service were predictors of their LOS. Operation history, a high Charlson comorbidity index, the type of insurance coverage, HHC admission route, and certain nursing care services were associated with admission and death as the DD.

Conclusions

Process variables (e.g., number of nurse visits, HHC admission route, type of nursing services) have a considerable influence on determining the LOS and DD of HHC patients. This result provides new insights into the use of HHC services and care transitions out of the hospital for patients living in their home, offering evidence to reduce unnecessary readmissions and ensure more effective and efficient HHC.

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影响家庭保健患者住院时间和出院目的地的因素：使用Donabedian模型的10年电子健康记录分析。

目的：探讨影响韩国家庭保健（HHC）患者住院时间（LOS）和出院目的地（DD）的因素。方法：对韩国某医院1769例患者的电子健康记录进行回顾性横断面研究。数据收集时间为2013年1月至2022年12月。根据Donabedian模型的修改，我们将自变量分为患者背景、结构和过程因素。采用层次和多项逻辑回归分析。结果：平均住院时间26.41 d。出院地点：35.0%继续HHC， 21.0%死亡，19%出院回家，17.0%入院，8.0%转至其他地点。患者的性别、保险覆盖类型、主要照顾者以及护士就诊次数、HHC入院路线和护理服务类型是其LOS的预测因子。手术史、高Charlson合并症指数、保险覆盖类型、HHC入院途径、特定护理服务与入院和死亡作为DD相关。结论：过程变量（如护士就诊次数、HHC入院途径、护理服务类型）对确定HHC患者的LOS和DD有相当大的影响。这一结果为住家患者使用HHC服务和出院后的护理过渡提供了新的见解，为减少不必要的再入院和确保更有效和高效的HHC提供了证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Japan Journal of Nursing Science 医学-护理

CiteScore

4.10

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： The Japan Journal of Nursing Science is the official English language journal of the Japan Academy of Nursing Science. The purpose of the Journal is to provide a mechanism to share knowledge related to improving health care and promoting the development of nursing. The Journal seeks original manuscripts reporting scholarly work on the art and science of nursing. Original articles may be empirical and qualitative studies, review articles, methodological articles, brief reports, case studies and letters to the Editor. Please see Instructions for Authors for detailed authorship qualification requirement.