Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: A randomized controlled trial of Acute Care for Elders (ACE) in a community hospital
Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: A randomized controlled trial of Acute Care for Elders (ACE) in a community hospital
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DOI：
10.1111/j.1532-5415.2000.tb03866.x
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发表时间：
2000-12-01
影响因子：
6.3
通讯作者：
Landefeld, CS
中科院分区：
文献类型：
--
作者：
Counsell, SR;Holder, CM;Landefeld, CS
背景技术背景：老年人在急性内科疾病和住院治疗后经常会出现功能下降。目的：为了检验一种多组分干预（称为老年人急性护理（ACE））将改善住院老年患者的功能结局和护理过程的假设。设计：随机对照试验。1994年11月至1997年5月，共有1531名70岁或以上的社区居民因急性内科疾病住院。干预：ACE包括一个专门设计的环境（例如，铺地毯和走廊整洁）;以病人为中心的护理，包括预防残疾和康复的护理计划;病人出院回家的计划;和审查的医疗护理，以防止医源性疾病。MEASUREMENTS：主要的结果是在日常生活的独立活动（ADL）从入院前2周（基线）出院的数量的变化。次要结果包括资源的使用，执行订单，以促进功能，病人和供应商satisfaction.Results：自我报告的措施，功能并没有不同的干预和常规护理组之间的意向治疗分析出院。出院时（34% vs 40%; P = 0.027）和住院后一年（P = 0.022），干预组ADL较基线下降或入住疗养院的复合结局较低。在住院时间和费用、家庭保健访问或再入院方面没有显著的组间差异。在干预组中，促进独立功能的护理计划更经常实施（79% vs 50%; P = .001），物理治疗咨询更频繁（42% vs 36%; P = .027），限制应用于更少的患者（2% vs 6%; r = .001）。患者、护理人员、医生和护士对干预组护理的满意度高于常规护理组（P
BACKGROUND: Older persons frequently experience a decline in function following an acute medical illness and hospitalization.OBJECTIVE: To test the hypothesis that a multicomponent intervention, called Acute Care for Elders (ACE), will improve functional outcomes and the process of care in hospitalized older patients.DESIGN: Randomized controlled trial.SETTING: Community teaching hospital.PATIENTS: A total of 1531 community-dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and May 1997.INTERVENTION: ACE includes a specially designed environment (with, for example, carpeting and uncluttered hallways); patient-centered care, including nursing care plans for prevention of disability and rehabilitation; planning for patient discharge to home; and review of medical care to prevent iatrogenic illness.MEASUREMENTS: The main outcome was change in the number of independent activities of daily living (ADL) from 2 weeks before admission (baseline) to discharge. Secondary outcomes included resource use, implementation of orders to promote function, and patient and provider satisfaction.RESULTS: Self-reported measures of function did not differ at discharge between the intervention and usual care groups by intention-to-treat analysis. The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at discharge (34% vs 40%; P =.027) and during the year following hospitalization (P = .022). There were no significant group differences in hospital length of stay and costs, home healthcare visits, or readmissions. Nursing care plans to promote independent function were more often implemented in the intervention group (79% vs 50%; P = .001), physical therapy consults were obtained more frequently (42% vs 36%; P = .027), and restraints were applied to fewer patients (2% vs 6%; r = .001). Satisfaction with care was higher for the intervention group than the usual care group among patients, caregivers, physicians, and nurses (P