同伴指导可降低脊髓损伤患者住院康复后的非计划性再入院率，并提高其自我效能。
Peer mentoring reduces unplanned readmissions and improves self-efficacy following inpatient rehabilitation for individuals with spinal cord injury.
机构信息
Shepherd Center, Virginia C Crawford Research Institute, Atlanta, Georgia, USA.
出版信息
J Spinal Cord Med. 2021 May;44(3):383-391. doi: 10.1080/10790268.2019.1645407. Epub 2019 Aug 12.
OBJECTIVE
Evaluate effectiveness of peer interventions on self-efficacy, unplanned hospital readmissions, and quality of life for patients with spinal cord injury (SCI) undergoing inpatient rehabilitation.
DESIGN
Interrupted time-series analysis (ITSA) examined effects of peer interventions on unplanned readmissions. Intervention variables added to ITSA regression examined relationships with exposure to peer interventions. Heterogeneity of treatment effects (HTE) analysis examined differences in intervention effectiveness for patients with quadriplegia and paraplegia.
SETTING
Rehabilitation hospital specializing in SCI and brain injury.
PARTICIPANTS
SCI inpatients ( = 1117) admitted for rehabilitation whose discharge location was home (77% male, 71% Caucasian, mean age 38.2 (SD 16.8)). A subsample of 799 patients participated in secondary analyses examining relationship between peer interventions, readmissions, changes in patient-reported outcomes, and HTE.
INTERVENTIONS
One-to-one mentoring and participation in peer-led self-management classes.
MAIN OUTCOME MEASURES
Unplanned readmissions, general self-efficacy (GSE), and depressive symptoms 30, 90, and 180 days post discharge; satisfaction with life at 180 days.
RESULTS
After implementing the peer interventions, we observed a significant decrease in both level and slope of number of patients readmitted, and level only of unplanned hospital days 30-days post-discharge. Reduction in the number of patients and unplanned hospital days was associated with number of peer visits but not peer-led education classes attended. Higher self-efficacy (GSE) was associated with greater exposure to peer mentoring, and a significant relationship between improvement in GSE and reduced hospital readmissions was observed.
CONCLUSIONS
One-to-one peer mentoring improves self-efficacy and reduces unplanned hospital readmissions following inpatient rehabilitation for persons with SCI.
目的
评估同伴干预对接受住院康复治疗的脊髓损伤（SCI）患者的自我效能感、非计划性住院再入院和生活质量的有效性。
设计
中断时间序列分析（ITSA）检查了同伴干预对非计划性再入院的影响。将干预变量添加到 ITSA 回归中，以检查与同伴干预接触的关系。治疗效果异质性（HTE）分析检查了四肢瘫痪和截瘫患者的干预效果差异。
设置
专门从事 SCI 和脑损伤康复的康复医院。
参与者
接受康复治疗的 SCI 住院患者（ = 1117 名，其中 77%为男性，71%为白种人，平均年龄 38.2（SD 16.8））。799 名患者的子样本参与了二次分析，以检查同伴干预、再入院、患者报告结果变化和 HTE 之间的关系。
干预措施
一对一指导和参与同伴主导的自我管理课程。
主要观察指标
出院后 30、90 和 180 天的非计划性再入院、一般自我效能感（GSE）和抑郁症状；出院后 180 天的生活满意度。
结果
在实施同伴干预措施后，我们观察到再入院患者人数的水平和斜率都显著下降，仅出院后 30 天的非计划性住院天数的水平下降。减少再入院患者人数和非计划性住院天数与同伴访问次数有关，但与参加的同伴主导教育课程次数无关。更高的自我效能感（GSE）与更多的同伴指导接触有关，并且观察到 GSE 改善与减少住院再入院之间存在显著关系。
结论
一对一的同伴指导可提高 SCI 住院康复患者的自我效能感并减少非计划性住院再入院。
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