Análise do escore Lace na readmissão hospitalar precoce em pacientes de clínica médica

Authors

  • Suelen Cristina Zandonadi Bernal
  • Vanessa Duarte de Souza
  • Roberta Graciele Saran da Silva
  • Paula Andrea Gatica Mercado
  • Cremide Aparecida Trindade Radovanovick

DOI:

https://doi.org/10.55905/revconv.17n.6-013

Keywords:

readmissão do paciente, hospitalização, medição de risco, cuidado transicional

Abstract

A readmissão hospitalar precoce é um fenômeno desafiador que afeta os sistemas de saúde globalmente, impondo consideráveis ônus financeiros às instituições de saúde e resultando em consequências adversas para os pacientes. Objetivo: Analisar o uso do escore LACE como ferramenta preditora de readmissão hospitalar precoce e verificar fatores associados. Método: Coorte retrospectiva de pacientes admitidos em clínica médica, entre 2020 e 2022. Para análise estatística foi usado o teste qui-quadrado, correlação Pearson, além da análise bivariada para verificar os fatores associados. Resultado: Dos 1.742 pacientes, a maioria era do sexo masculino, raça branca, idade média de 61 anos, com ensino fundamental. Destes 238 pacientes foram readmitidos em até 30 dias, com taxa de readmissão de 13,66%. O escore LACE indicou alto risco de readmissão para 63,26% dos pacientes. Associações significativas foram encontradas entre readmissão e escolaridade (p = 0,039) e categorias do escore LACE (p = 0,018).Conclusão: Destaca-se a importância do escore LACE e fatores sociodemográficos na identificação de pacientes com maior probabilidade de readmissão, sugerindo estratégias de cuidados pós-alta direcionadas para melhorar resultados clínicos e reduzir taxas de readmissão.

References

ALMEIDA, Diego Souza Silva. Saúde digital: predição do risco de reinternação em hospitais universitários federais. 2021. Dissertação (Mestrado em Saúde Digital)- Universidade Católica de Brasília, Brasília, 2021. Disponível em: https://bdtd.ucb.br:8443/jspui/handle/tede/2838. Acesso em: 13 ago. 2022.

ANANDAN, Samuel et al. A Retrospective Study Analyzing a Palliative Care-Hospital Medicine Collaboration to Improve Quality of Care of Patients With Advanced Illness. American Journal of Hospice and Palliative Medicine®, Los Angeles, CA, v. 40, n. 3, p. 299–310, 2023. Disponível em: http://journals.sagepub.com/doi/10.1177/10499091221101566.

AUBERT, Carole E. et al. HOSPITAL Score and LACE Index to Predict Mortality in Multimorbid Older Patients. Drugs & Aging, [s. l.], v. 39, n. 3, p. 223–234, 2022. Disponível em: https://doi.org/10.1007/s40266-022-00927-0.

BARNES, Sean et al. Real-time prediction of inpatient length of stay for discharge prioritization. Journal of the American Medical Informatics Association : JAMIA, United States, v. 23, n. e1, p. e2, 2016. Disponível em: /pmc/articles/PMC4954620/. Acesso em: 17 jan. 2023.

BERNARDINO, Elizabeth et al. Enfermeiras de ligação na gestão de altas do complexo Hospital de Clínicas. Enfermagem em Foco, Brasil, v. 12, p. 72–76, 2021.

BUCKMAN, Mercy et al. A review of socioeconomic factors associated with acute myocardial infarction-related mortality and hospital readmissions. Hospital Practice, United Kingdom, v. 50, n. 1, p. 1–8, 2022.

DADIOMOV, David; KEEFER, Patricia; SMITH, Michael A. Using the LACE Score as a Predictor of Clinical Outcomes in Patients Referred for Inpatient Palliative Care Consultation: A Single-Center Experience. American Journal of Hospice and Palliative Medicine®, United States, p. 104990911879317, 2018. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30064238/.

DE OLIVEIRA, Larissa Marina Santana Mendonça et al. Readmission of patients with acute coronary syndrome and determinants. Arquivos Brasileiros de Cardiologia, Brasil, v. 113, n. 1, p. 42–49, 2019.

DIAS, Bruna Moreno et al. Ocorrência de readmissões hospitalares em um município de grande porte populacional. Revista de Administração em Saúde, Brasil, v. 21, n. 83, 2021. Disponível em: https://cqh.org.br/ojs-2.4.8/index.php/ras/article/view/285/431. Acesso em: 5 jan. 2023.

FLUCK, D et al. High LACE index scores are associated with disproportionate excess deaths in hospital amongst patients with COVID-19. Intern Emerg Med, Itália, v. 17, n. 7, p. 1891–1897, 2022. Disponível em: https://www.embase.com/search/results?subaction=viewrecord&id=L638305103&from=expor.

GIOLO, Suely. Introdução à Análise de Dados Categóricos com Aplicações. Brasil, 2017.

GOMES LABEGALINI, Célia Maria et al. Atendimento de saúde à pessoas hipertensas e diabéticas: percepção de enfermeiros/ Health care for hypertensive and diabetic people: nurses’ perception. Ciência, Cuidado e Saúde, Brasil, v. 21, p. 0–2, 2022. Disponível em: https://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/61580.

GRUNEIR, Andrea et al. Unplanned readmissions after hospital discharge among patients identified as being at high risk for readmission using a validated predictive algorithm. Open Med., A. Gruneir, 790 Bay St., 7th floor, Toronto, ON, Canada, v. 5, n. 2, p. 104–111, 2011. Disponível em: https://www.embase.com/search/results?subaction=viewrecord&id=L362826893&from=export.

HEPPLESTON, E et al. LACE index predicts age-specific unplanned readmissions and mortality after hospital discharge. Aging Clin. Exp. Res., T.S. Han, Department of Endocrinology, Ashford and St Peter’s Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, United Kingdom, v. 33, n. 4, p. 1041–1048, 2021. Disponível em: https://www.embase.com/search/results?subaction=viewrecord&id=L2005165437&from=export.

HOFFMAN, Geoffrey J et al. Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older. JAMA Network Open, United States, v. 2, n. 5, p. e194276, 2019. Disponível em: http://jamanetworkopen.jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2019.4276.

LABROSCIANO, C et al. The LACE Index: A Predictor of Mortality and Readmission in Patients With Acute Myocardial Infarction. Journal for Healthcare Quality, United States, v. 43, n. 5, p. 292–303, 2021. Disponível em: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85115444263&doi=10.1097%2FJHQ.0000000000000296&partnerID=40&md5=fcc2810aed1f738b7737dc0240039d95.

LEE, S Y et al. Feasibility of a guided participation discharge program for very preterm infants in a neonatal intensive care unit: a randomized controlled trial. BMC pediatrics, Unites Kingdom, v. 19, n. 1, p. 402, 2019.

LOW, Lian Leng et al. Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial. PLOS ONE, United States, v. 12, n. 1, p. e0168757, 2017. Disponível em: https://dx.plos.org/10.1371/journal.pone.0168757. Acesso em: 6 mar. 2023.

MAI BA, Hai et al. Transitional Care Interventions for Patients with Heart Failure: An Integrative Review. International journal of environmental research and public health, Switzerland, v. 17, n. 8, 2020.

MALTA, Monica et al. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Revista de Saúde Pública, Brasil, v. 44, n. 3, p. 559–565, 2010. Disponível em: http://www.consort-statement.org/consort-statement/.

MAYNARD, Roy et al. Home Health Care Availability and Discharge Delays in Children With Medical Complexity. Pediatrics, United States, v. 143, n. 1, 2019. Disponível em: https://publications.aap.org/pediatrics/article/143/1/e20181951/76858/Home-Health-Care-Availability-and-Discharge-Delays.

MCALISTER, Finlay A. et al. Similar outcomes among general medicine patients discharged on weekends. Journal of hospital medicine, United States, v. 10, n. 2, p. 69–74, 2015. Disponível em: https://pubmed.ncbi.nlm.nih.gov/25537769/. Acesso em: 24 fev. 2024.

MOUNAYAR, Anne-Laure et al. Development of a risk prediction model of potentially avoidable readmission for patients hospitalised with community-acquired pneumonia: study protocol and population. BMJ Open, United Kingdom, v. 10, n. 11, p. e040573, 2020. Disponível em: https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2020-040573.

RISING, Kristin L et al. Patient Uncertainty as a Predictor of 30‐day Return Emergency Department Visits: An Observational Study. Academic Emergency Medicine, United States, v. 26, n. 5, p. 501–509, 2019. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/acem.13621.

ROBERT, Benoît et al. A Case-Control Study of the Sub-Acute Care for Frail Elderly (SAFE) Unit on Hospital Readmission, Emergency Department Visits and Continuity of Post-Discharge Care. Journal of the American Medical Directors Association, United States, v. 22, n. 3, p. 544-550.e2, 2021. Disponível em: https://linkinghub.elsevier.com/retrieve/pii/S1525861020306319.

RODRIGUES, Thamires Fernandes Cardoso da Silva et al. Planejamento de alta realizado por enfermeiros para o aumento da competência de cuidadores: Ensaio Clínico. Texto & Contexto - Enfermagem, Brasil, v. 32, p. 1–16, 2023. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-07072023000100386&tlng=pt.

ROTHMAN, Kenneth J.; GREENLAND, Sander; TIMOTHY L. LASH. Epidemiologia moderna. 3a Ediçãoed. SÃO PAULO: Lippincott Williams & Wilkins/Wolters Kluwer Health Inc. USA Indicações, 2011.

SALUK, Jennifer L. et al. The LACE Score as a Tool to Identify Radical Cystectomy Patients at Increased Risk of 90-Day Readmission and Mortality. Current Urology,United States, v. 12, n. 1, p. 20–26, 2018. Disponível em: https://journals.lww.com/01330296-201812010-00004. Acesso em: 24 fev. 2024.

SHAFFER, Brett K.; CUI, Yu; WANDERER, Jonathan P. Validation of the LACE readmission and mortality prediction model in a large surgical cohort: Comparison of performance at preoperative assessment and discharge time points. J. Clin. Anesth., J.P. Wanderer, Vanderbilt University Medical Center, 2301 Vanderbilt University Hospital, Nashville, TN, United States, v. 58, n. April, p. 22–26, 2019. Disponível em: https://www.embase.com/search/results?subaction=viewrecord&id=L2001902869&from=export.

SOARES, Vinícius Sabedot. Validação do escore LACE em uma população brasileira como preditor de readmissão ou óbito em até 30 dias após a alta hospitalar. 2020. 50 f. - Wagner Wessfll, Brasil, 2020.

SOARES, Vinícius Sabedot; PINTO, Maria Eugênia Bresolin. Aplicação do escore LACE para predição de readmissões hospitalares: Uma revisão / Using the LACE index for predicting hospital readmissions: A review. Brazilian Journal of Development, Brasil, v. 7, n. 12, p. 111550–111564, 2021. Disponível em: https://www.brazilianjournals.com/index.php/BRJD/article/view/40652/pdf. Acesso em: 19 maio 2022.

THIRLWELL, S et al. Abstracts of the MASCC/ISOO 2017 Annual Meeting. Supportive Care in Cancer, S. Thirlwell, H. Lee Moffitt Cancer Center, Supportive Care Medicine, Tampa, United States, v. 25, n. S2, p. 21–266, 2017. Disponível em: https://www.embase.com/search/results?subaction=viewrecord&id=L616191515&from=export.

VAN WALRAVEN, C. et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. Canadian Medical Association Journal, Canadá, v. 182, n. 6, p. 551–557, 2010. Disponível em: https://pubmed.ncbi.nlm.nih.gov/20194559/. Acesso em: 19 maio 2022.

YAZDAN-ASHOORI, Payam et al. Utility of the LACE index at the bedside in predicting 30-day readmission or death in patients hospitalized with heart failure. American Heart Journal, United States, v. 179, p. 51–58, 2016. Disponível em: https://linkinghub.elsevier.com/retrieve/pii/S0002870316300941. Acesso em: 19 maio 2022.

ZANETONI, Tatiane Cristina; CUCOLO, Danielle Fabiana; PERROCA, Marcia Galan. Alta hospitalar responsável: validação de conteúdo de atividades do enfermeiro. Revista Gaúcha de Enfermagem, Brasil, v. 43, p. 1–10, 2022. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472022000100418&tlng=pt.

ZIMMERMANN, Bettina M et al. Factors associated with post-acute discharge location after hospital stay: a cross-sectional study from a Swiss hospital. BMC health services research, United Kingdom, v. 19, n. 1, p. 289, 2019.

Published

2024-06-03

How to Cite

Bernal, S. C. Z., Souza, V. D. de, Silva, R. G. S. da, Mercado, P. A. G., & Radovanovick, C. A. T. (2024). Análise do escore Lace na readmissão hospitalar precoce em pacientes de clínica médica. CONTRIBUCIONES A LAS CIENCIAS SOCIALES, 17(6), e7210. https://doi.org/10.55905/revconv.17n.6-013

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