COMPREHENSIVE DISCHARGE PLANNING FOR THE HOSPITALIZED ELDERLY - A RANDOMIZED CLINICAL-TRIAL
COMPREHENSIVE DISCHARGE PLANNING FOR THE HOSPITALIZED ELDERLY - A RANDOMIZED CLINICAL-TRIAL
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DOI：
10.7326/0003-4819-120-12-199406150-00005
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发表时间：
1994-06-15
影响因子：
39.2
通讯作者：
PAULY, M
中科院分区：
文献类型：
--
作者：
NAYLOR, M;BROOTEN, D;PAULY, M
目的：为了研究一个全面的出院计划协议，专门为老年人设计和实施的护理专家，对病人和照顾者的结果和costsofcare.Design的影响：随机临床试验。设置：宾夕法尼亚大学医院。患者：276例患者和125名照顾者。患者年龄在70岁及以上，并被安排在选定的内科和外科心脏诊断相关组。患者结局的组间差异（初次住院时间、初次出院与再次入院之间的时间、再住院率）和护理费用（首次住院、再住院、出院后的卫生服务和护士专家服务的费用）进行了测量2，6，结果：从出院到出院后6周，干预组患者再入院次数少，再住院总天数少，再入院费用低，出院后医疗服务费用低。在这些结果之间没有差异，发现在此期间的手术干预和对照组。结论：研究结果支持需要为老年人设计的全面出院计划，并实施护理专家，以改善他们的结果出院后，并实现成本节约。研究结果还表明，在出院后的前6周内，这种干预在延迟或防止医疗干预组患者再次住院方面效果最大。
Objective: To study the effects of a comprehensive discharge planning protocol, designed specifically for the elderly and implemented by nurse specialists, on patient and caregiver outcomes and cost of care.Design: Randomized clinical trial.Setting: Hospital of the University of Pennsylvania.Patients: 276 patients and 125 caregivers. Patients were 70 years and older and were placed in selected medical and surgical cardiac diagnostic-related groups.Measurements: Group differences in patient outcomes (length of initial hospital stay, length of time between initial hospital discharge and readmission, and rehospitalization rates) and charges for care (charges for initial hospitalization, rehospitalizations, health services after discharge, and nurse specialist services) were measured 2, 6, and 12 weeks after discharge.Results: From the initial hospital discharge to 6 weeks after discharge, patients in the medical intervention group had fewer readmissions, fewer total days rehospitalized, lower readmission charges, and lower charges for health care services after discharge. No differences in these outcomes were found between the surgical intervention and control groups during this period.Conclusions: Study findings support the need for comprehensive discharge planning designed for the elderly and implemented by nurse specialists to improve their outcomes after hospital discharge and to achieve cost savings. The findings also suggest that this intervention had its greatest effect in delaying or preventing rehospitalization of patients in the medical intervention group during the first 6 weeks after discharge.