An innovative rehabilitation program for the veterans affairs post-acute skilled nursing setting: Preliminary results.
An innovative rehabilitation program for the veterans affairs post-acute skilled nursing setting: Preliminary results.
复制标题
退伍军人事务急性熟练护理环境后的创新康复计划：初步结果。
DOI：
10.1111/jgs.18214
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发表时间：
2023
影响因子：
6.3
通讯作者：
Bean,JonathanF
中科院分区：
文献类型：
--
作者：
Ashcroft,Taarika;Middleton,Addie;Driver,JaneA;Ruopp,Marcus;Harris,Rebekah;Bean,JonathanF
背景：熟练的护理康复护理在老年人的功能恢复中起着至关重要的作用，影响出院后的预后。急性后康复护理服务和患者结果的差异表明需要改善这种情况下的康复护理。我们采用了一个成功的门诊护理项目（Live Long Walk Strong‐LLWS）来解决退伍军人健康管理局急性期后护理环境中的这一需求。LLWS与标准PT护理的不同之处在于，它治疗与功能衰退相关的损伤，而这些损伤传统上不是标准护理的目标，它提供正式的指导以优化行为改变，并提供出院后病例管理以优化长期结果。目的是为社区生活中心（CLC）调整、完善和实施LLWS计划，确定其可接受性和可行性，并评估其在老年人中的初步有效性。方法通过质量改进方法和复制有效程序（REP）框架，将原门诊LLWS程序的设计调整为CLC设置。主要结果包括可行性和可接受性的测量，80%的入组和疗程的完成，以及使用基于表现和患者报告的功能测量的初步有效性，包括短物理性能电池（SPPB）， AM - PAC，全球变化评级问卷和满意度调查。结果18个月后，51名退伍军人参加了LLWS项目，94.1%的人保持了注册。我们观察到80%的住院和家庭随访的完成率。大多数患者对护理非常满意。SPPB （2.3 （SD 2.2）点）、步态速度（0.17 (0.14)m/s）和AM - PAC （6.5 (SD 5.7)）的改善超过了临床意义的阈值。结论这种新颖的护理方案对退伍军人是可行和可接受的，在改善功能预后方面显示出初步的效果。未来的研究需要进一步研究该计划对其他重要结果的影响，而不是标准的护理模式。
BackgroundSkilled nursing rehabilitative care plays a critical role in older adults' functional recovery impacting post‐discharge outcomes. Variations across post‐acute rehabilitative care services and patient outcomes indicate a need to improve rehabilitative care in this setting. We adapted a successful outpatient care program (Live Long Walk Strong‐LLWS) to address this need in post‐acute care settings within the Veterans Health Administration. LLWS differs from standard PT care by treating impairments linked to functional decline that are not traditionally targeted by standard care, providing formalized coaching to optimize behavior change, and providing post‐discharge case management to optimize long‐term outcomes. The purpose was to adapt, refine and implement the LLWS program for the Community Living Center (CLC), determine its acceptability and feasibility, and evaluate its preliminary effectiveness among older adults.MethodsThe design of the program was adapted from the original outpatient LLWS program to the CLC setting through quality improvement methods and the Replicating Effective Programs (REP) framework. Primary outcomes included measures of feasibility and acceptability of >80% enrollment and completion of sessions as well as preliminary effectiveness using performance‐based and patient‐reported measures of function including the Short Physical Performance Battery (SPPB), AM‐PAC, a Global Rating of Change questionnaire, and a satisfaction survey.ResultsAfter 18 months, 51 Veterans had enrolled in the LLWS program, with 94.1% maintaining enrollment. We observed >80% completion of the inpatient and home follow‐up sessions. Most patients were highly satisfied with care. Improvements in the SPPB (2.3 (SD 2.2) points), gait speed (0.17 (0.14) m/s) and the AM‐PAC (6.5 (SD 5.7)) surpassed clinically meaningful thresholds.ConclusionsThis novel care program is feasible and acceptable to Veterans, demonstrating preliminary effectiveness with improving functional outcomes. Future research is needed to further examine the program's impact on other important outcomes relative to standard modes of care.