对扩大服务范围以纳入射血分数保留型心力衰竭患者的评估

Jessica Peplow, Sharon Rees
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摘要

西赫特福德郡中央伦敦社区医疗信托基金的心力衰竭服务于 2020 年扩大,除了射血分数降低的心力衰竭患者外,还包括射血分数保留的心力衰竭患者。预计患者人数将增加一倍,需要对人员和服务进行调整;因此需要进行评估,以确定护理目标是否得以维持。本研究旨在评估服务扩展对服务转诊率、服务停留时间和临床工作量的影响。研究人员对 2020 年 10 月至 2021 年 4 月期间的服务数据进行了回顾性定量评估,以比较射血分数降低型心力衰竭患者和射血分数保留型心力衰竭患者的转诊率、住院时间和主要工作量指标。所有新诊断为心力衰竭(经超声心动图或磁共振成像确认)的转诊患者均被纳入评估范围。在250名符合条件的转诊者中,采用随机抽样的方法选取了81人进行评估。数据分析采用卡方检验、费雪精确检验或 Wilcoxon 符号秩检验;P 值小于 0.05 表示统计学意义显著。射血分数保留型心力衰竭患者的住院时间中位数为17周。射血分数减低型心力衰竭患者的住院时间为35.57周(P<0.001),而扩容前的住院时间约为17周。两组患者的工作量成正比。射血分数保留型心力衰竭患者更有可能接受多学科团队或顾问社区诊所的复查。这组患者到诊所就诊的可能性较低,96.4%的面对面复查是在家中进行的。两组患者接受电话复查的频率相似,均占随访的50%。射血分数降低的心力衰竭患者需要进行更多的药物治疗和药物滴定,因此需要进行更多的随访。将射血分数保留型心力衰竭患者纳入服务范围对工作量产生了重大影响,导致射血分数降低型心力衰竭患者的护理质量下降。
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An evaluation of a service expansion to include patients with heart failure with preserved ejection fraction
The Central London Community Healthcare Trust West Hertfordshire heart failure service expanded in 2020 to include patients with heart failure with preserved ejection fraction, in addition to the patients with heart failure with reduced ejection fraction. The patient population was predicted to double, requiring staff and service adjustments; this warranted an evaluation to determine if care targets were maintained. This study aimed to evaluate the impact of service expansion on service referral rates, length of stay in the service and clinical workload. A retrospective quantitative evaluation of the service data from October 2020 to April 2021 was undertaken to compare referral rates, length of stay in the service and key workload metrics between patients with heart failure with reduced ejection fraction and those with heart failure with preserved ejection fraction. All referrals to the service with a new diagnosis of heart failure (confirmed by echocardiogram or magnetic resonance imaging) were considered for evaluation. Of 250 eligible referrals, 81 were selected for inclusion using a random sampling method. Data were analysed using Chi square test, Fisher’s exact test or the Wilcoxon signed rank test; a P value of <0.05 indicated statistical significance. The participants with heart failure with preserved ejection fraction had a median length of stay in the service of 17 weeks. The participants with heart failure with reduced ejection fraction had a significantly longer stay of 35.57 weeks (P<0.001) compared to a pre-expansion length of stay of approximately 17 weeks. Workload was proportional between the two cohorts. Patients with heart failure with preserved ejection fraction were more likely to be reviewed in multidisciplinary teams or by the consultant community clinic. This group was less likely to attend clinic, with 96.4% of face-to-face reviews taking place at home. Telephone reviews occurred at a similar frequency for both cohorts, comprising 50% of follow ups. The heart failure with reduced ejection fraction cohort required more alterations in medication and medication titration, generating additional follow ups. The service expansion to include patients with heart failure with preserved ejection fraction has had a significant impact on workload, leading to a reduction in the quality of care for those with heart failure with reduced ejection fraction.
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