A controlled trial of inpatient and outpatient geriatric evaluation and management
A controlled trial of inpatient and outpatient geriatric evaluation and management
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DOI：
10.1056/nejmsa010285
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发表时间：
2002-03-21
影响因子：
158.5
通讯作者：
Brodkin, K
中科院分区：
文献类型：
--
作者：
Cohen, HJ;Feussner, JR;Brodkin, K
背景：在过去的20年里，住院单位和门诊诊所都制定了老年评估和管理方案。然而，这些干预措施对生存和功能状态的影响仍不确定。方法：我们进行了一项随机试验，纳入了在11个退伍军人事务医疗中心住院的65岁及以上体弱患者。在病情稳定后，根据二乘二因子设计，患者被随机分配到老年住院病房或普通住院病房接受治疗，随后在老年门诊诊所或普通门诊接受治疗。干预措施涉及根据退伍军人事务标准和已公布的指导方针提供老年评估和管理的小组。主要结局是生存和健康相关的生活质量，在随机化一年后使用医学结局研究36项简短一般健康调查（SF-36）进行测量。次要结局是进行日常生活活动的能力、身体表现、卫生服务的利用和费用。结果：共有1388例患者入组并随访。住院和门诊干预对死亡率都没有显著影响（一年内总体为21%），两种干预之间也没有任何协同效应。出院时，分配到老年住院病房的患者在8个SF-36亚量表中的4个得分、日常生活活动和身体表现方面的改善明显大于分配到普通住院护理的患者。一年后，分配到老年门诊的患者在SF-36心理健康量表上的得分高于分配到常规门诊的患者，即使在出院时对得分进行了调整。干预组和常规护理组一年的总费用相似。结论：在这项对照试验中，老年住院病房和老年门诊提供的护理对生存率没有显著影响。住院老年评估和管理显著减少了功能衰退，门诊老年评估和管理改善了精神健康，而成本没有增加。[J] .中华医学杂志2002；33(4):391 - 391。版权所有(C) 2002马萨诸塞州医学协会。
Background: Over the past 20 years, both inpatient units and outpatient clinics have developed programs for geriatric evaluation and management. However, the effects of these interventions on survival and functional status remain uncertain.Methods: We conducted a randomized trial involving frail patients 65 years of age or older who were hospitalized at 11 Veterans Affairs medical centers. After their condition had been stabilized, patients were randomly assigned, according to a two-by-two factorial design, to receive either care in an inpatient geriatric unit or usual inpatient care, followed by either care at an outpatient geriatric clinic or usual outpatient care. The interventions involved teams that provided geriatric assessment and management according to Veterans Affairs standards and published guidelines. The primary outcomes were survival and health-related quality of life, measured with the use of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), one year after randomization. Secondary outcomes were the ability to perform activities of daily living, physical performance, utilization of health services, and costs.Results: A total of 1388 patients were enrolled and followed. Neither the inpatient nor the outpatient intervention had a significant effect on mortality (21 percent at one year overall), nor were there any synergistic effects between the two interventions. At discharge, patients assigned to the inpatient geriatric units had significantly greater improvements in the scores for four of the eight SF-36 subscales, activities of daily living, and physical performance than did those assigned to usual inpatient care. At one year, patients assigned to the outpatient geriatric clinics had better scores on the SF-36 mental health subscale, even after adjustment for the score at discharge, than those assigned to usual outpatient care. Total costs at one year were similar for the intervention and usual-care groups.Conclusions: In this controlled trial, care provided in inpatient geriatric units and outpatient geriatric clinics had no significant effects on survival. There were significant reductions in functional decline with inpatient geriatric evaluation and management and improvements in mental health with outpatient geriatric evaluation and management, with no increase in costs. (N Engl J Med 2002;346:905-12.) Copyright (C) 2002 Massachusetts Medical Society.