A MULTIDISCIPLINARY INTERVENTION TO PREVENT THE READMISSION OF ELDERLY PATIENTS WITH CONGESTIVE-HEART-FAILURE
A MULTIDISCIPLINARY INTERVENTION TO PREVENT THE READMISSION OF ELDERLY PATIENTS WITH CONGESTIVE-HEART-FAILURE
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DOI：
10.1056/nejm199511023331806
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发表时间：
1995-11-02
影响因子：
158.5
通讯作者：
CARNEY, RM
中科院分区：
文献类型：
--
作者：
RICH, MW;BECKHAM, V;CARNEY, RM
背景资料。充血性心力衰竭是老年人入院的最常见指征。行为因素，如治疗依从性差，经常导致心力衰竭的恶化，这一事实表明，许多入院治疗是可以预防的。我们进行了一项前瞻性随机试验，研究护士指导的多学科干预对70岁或70岁以上因充血性心力衰竭住院的高危患者出院后90天内的再住院率、生活质量和护理费用的影响。干预措施包括对患者及家属的全面教育、处方饮食、社会服务咨询和提前出院计划、药物复习和强化随访。治疗组142名患者中有91名患者在没有再次入院的情况下存活了90天，而接受传统护理的140名对照组患者中有75名患者接受了常规护理(P=0.09)。对照组再入院94例，治疗组再入院53例(风险比，0.56；P=0.02)。治疗组因心力衰竭再次住院的次数减少了56.2%(54次，对照组为24次；P=0.04)，而因其他原因再次住院的次数减少了28.5%(40次对29次，P不显著)。对照组23例(16.4%)再入院一次以上，治疗组9例(6.3%)再入院1次以上(风险比0.39；P=0.01)。在一个由126名患者组成的亚组中，治疗组患者在90天时的生活质量评分比基线改善得更多(P=0.001)。由于住院人数的减少，治疗组每个患者的总体护理费用减少了460美元。护士指导的多学科干预可以提高老年充血性心力衰竭患者的生活质量，减少医院使用和医疗成本。
Background. Congestive heart failure is the most common indication for admission to the hospital among older adults. Behavioral factors, such as poor compliance with treatment, frequently contribute to exacerbations of heart failure, a fact suggesting that many admissions could be prevented.Methods. We conducted a prospective, randomized trial of the effect of a nurse-directed, multidisciplinary intervention on rates of readmission within 90 days of hospital discharge, quality of life, and costs of care for high-risk patients 70 years of age or older who were hospitalized with congestive heart failure. The intervention consisted of comprehensive education of the patient and family, a prescribed diet, social-service consultation and planning for an early discharge, a review of medications, and intensive follow-up.Results. Survival for 90 days without readmission, the primary outcome measure, was achieved in 91 of the 142 patients in the treatment group, as compared with 75 of the 140 patients in the control group, who received conventional care (P = 0.09). There were 94 readmissions in the control group and 53 in the treatment group (risk ratio, 0.56; P = 0.02). The number of readmissions for heart failure was reduced by 56.2 percent in the treatment group (54, vs. 24 in the control group; P = 0.04), whereas the number of readmissions for other causes was reduced by 28.5 percent (40 vs. 29, P not significant). In the control group, 23 patients (16.4 percent) had more than one readmission, as compared with 9 patients (6.3 percent) in the treatment group (risk ratio, 0.39; P = 0.01). In a subgroup of 126 patients, quality-of-life scores at 90 days improved more from base line for patients in the treatment group (P = 0.001). Because of the reduction in hospital admissions, the overall cost of care was $460 less per patient in the treatment group.Conclusions. A nurse-directed, multidisciplinary intervention can improve quality of life and reduce hospital use and medical costs for elderly patients with congestive heart failure.