Evaluation of restorative care vs usual care for older adults receiving an acute episode of home care
Evaluation of restorative care vs usual care for older adults receiving an acute episode of home care
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DOI：
10.1001/jama.287.16.2098
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发表时间：
2002-04-24
影响因子：
120.7
通讯作者：
O'Leary, J
中科院分区：
文献类型：
--
作者：
Tinetti, ME;Baker, D;O'Leary, J
疾病和住院常常引发老年人的功能下降。为功能衰退实施的家庭护理服务提供了一个机会，干预以改善结果。目的比较恢复性护理与常规家庭护理患者的功能状态和留在家中的可能性。在1998年11月1日至2000年4月30日期间，采用前瞻性个体匹配设计和设置干预措施。研究使用了康涅狄格州一家家庭护理机构的六个办公室。一个分支机构作为康复护理单位，另外5个分支机构作为常规护理办公室。参与者：65岁及以上通过恢复性护理办公室接受家庭护理的患者；接受医疗保险覆盖的家庭护理，持续时间不超过7天；没有严重的认知障碍；而不是晚期、卧床不起或需要全面护理的患者与来自常规护理办公室的患者相匹配。匹配因素包括年龄、性别、种族、基线自我护理功能、认知状况、是否在居家护理发作前住院以及居家护理发作的日期。在712例符合条件的恢复性护理患者中，691例（97%）与常规护理患者匹配。干预恢复性护理，由家庭护理机构护理、治疗和家庭健康助理人员提供，是基于老年医学的原则。护理、康复和目标实现。主要观察指标：留在家中，完成家庭护理时的功能状况，以及家庭护理的持续时间和强度。结果：与常规护理相比，在调整基线特征和其他因素后，恢复性护理与更大的留在家中的可能性（82% vs 71%；优势比[OR]， 1.99； 95%可信区间[CI]， 1.47-2.69）和更低的去急诊室的可能性相关（10% vs 20%； OR, 0.44; 95% CI, 0.32-0.61）。家庭护理发作时间较短(平均[SD]， 24.8[26.8]天对34.3[44.2]天；S = -17821； P
Context Illness and hospitalization often trigger functional decline among older persons. Home care services implemented for functional decline provide an opportunity, to intervene to improve outcomes.Objective To compare functional status and the likelihood of remaining at home for persons receiving restorative care vs usual home care.Design and Setting Intervention using prospective individual matching conducted between November 1, 1998, and April 30, 2000. Six offices of a home care agency in Connecticut were used. One branch office served as the restorative care unit and the other 5 served as usual care offices.Participants Patients receiving home care through the restorative care office who were 65 years or older; in receipt of Medicare-covered home care lasting at beast 7 days; with absence of severe cognitive impairment; and not terminal, bedridden, or requiring total care were matched with patients from 1 of the usual care offices. The matching factors included age, sex, race, baseline self-care function, cognitive status, whether hospitalization preceded the home care episode, and date of the home care episode. Of the 712 eligible restorative care patients, 691 (97%) were matched with a usual care patient.Intervention Restorative care, provided by the home care agency nursing, therapy, and home health aide staff, was based on principles from geriatric medicine., nursing, rehabilitation, and goal attainment.Main Outcome Measures Remaining at home, functional status at completion of the home care episode, and duration and intensity of home care episode. Results Compared with usual care, and after adjusting for baseline characteristics and other factors, restorative care was associated with a greater likelihood of remaining at home (82% vs 71%; odds ratio [OR], 1.99; 95% confidence interval [CI], 1.47-2.69) and a reduced likelihood of visiting an emergency department (10% vs 20%; OR, 0.44; 95% CI, 0.32-0.61). Home care episodes were shorter (mean [SD], 24.8 [26.8] days vs 34.3 [44.2] days; S = -17821; P