RESEARCH IN NURSING-HOMES - PRACTICAL ASPECTS
RESEARCH IN NURSING-HOMES - PRACTICAL ASPECTS
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DOI：
10.1111/j.1532-5415.1993.tb02055.x
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发表时间：
1993-02-01
影响因子：
6.3
通讯作者：
SCHNELLE, JF
中科院分区：
文献类型：
--
作者：
OUSLANDER, JG;SCHNELLE, JF
United States.由于许多NH居民的逗留时间短，流动率高，在给定的一年中，有150多万人在NH度过一段时间。尽管越来越多的社区为基础的长期护理计划，社会人口的变化和经济的考虑将导致在未来几十年内越来越需要NH护理。最近的估计表明，在1990年65岁的美国人中，43%的人将在NH度过一段时间。关于提高疗养院护理质量的必要性已经写了很多。护理NH居民的临床医生通常面临着诊断和治疗的困境，因为后勤和资源的限制，NH人口的脆弱性，在决策中涉及许多痴呆症居民的困难，以及缺乏指导，从科学有效的数据最有效的诊断和治疗策略。很少有数据，如果有的话，目前可从研究的年轻人群，甚至非制度化的老年人群是适用于临床医生在NH设置。与此同时，卫生保健融资管理局（HCFA）正在颁布关于国家卫生机构临床护理的规则，这些规则充其量是基于专家意见，而没有充分的临床试验基础。有一个明确的需要进行试验，严格审查的有效性，成本和适当性，许多常用的（可能是一些未充分使用）的诊断和治疗干预NH居民。自1981年Robert Butler博士呼吁发展“教学疗养院”以来，5国家老龄问题研究所、Robert Wood约翰逊基金会6和其他几个基金会都支持在NH环境中开展研究项目。超过100所医学院已经报告了与NHS的一些联系，并且在这种情况下研究了各种各样的主题。然而，除了几项关于泌尿系统行为干预的研究外，大多数研究都是描述性的或面向健康服务的。从这些研究中可以清楚地看出，为了完成上述急需的临床干预试验，
Unites States. Because of the short length of stay and high turnover rate of many NH residents, substantially more than 1.5 million people spend some time in a NH during a given year. Despite the growing number of community based long-term care programs, sociodemographic changes and economic considerations will result in growing need for NH care over the next several decades. Recent estimates suggest that for the cohort of Americans age 65 in the year 1990, 43% will spend some time in a NH.’Much has been written about the need to improve the quality of care in nursing homes (NHs).’-~ Clinicians who care for NH residents are commonly faced with diagnostic and therapeutic dilemmas because of logistical and resource constraints, the frailty of the NH population, difficulties in involving many demented residents in decision making, and the lack of guidance from scientifically valid data on the most effective diagnostic and therapeutic strategies. Few if any data currently available from studies of younger populations or even non-institutionalized geriatric populations are applicable for clinicians in the NH setting. At the same time, the Health Care Financing Administration (HCFA) is promulgating rules for clinical care in NHs that are, at best, based on expert opinion without an adequate basis in clinical trials. There is a clear need for trials that critically examine the effectiveness, cost, and appropriateness of many commonly used (and probably some underused) diagnostic and therapeutic interventions in NH residents. Since Dr. Robert Butler called for the development of “teaching nursing homes” in 1981, 5 the National Institute on Aging, the Robert Wood Johnson Foundation, 6 and several other foundations have supported research projects in NH settings. Over 100 medical schools have reported some affiliations with NHs, and a wide variety of topics have been studied in this setting.’-” With the exception of several studies of behavioral interventions for urinary however, most research has been descriptive or health services oriented in nature. It has become clear from these studies that, in order to accomplish the much needed clinical intervention trials alluded to above,