Impact on hospital admissions of an integrated primary care model for very frail elderly patients
Impact on hospital admissions of an integrated primary care model for very frail elderly patients
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DOI：
10.1016/j.archger.2014.01.005
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发表时间：
2014-05-01
影响因子：
4
通讯作者：
Ankri, Joel
中科院分区：
文献类型：
--
作者：
de Stampa, Matthieu;Vedel, Isabelle;Ankri, Joel
居住在社区的年老体弱的病人，有复杂的需要，急诊科（ED）的入院率较高。在这里，我们评估了COPA模式（协调人员协议）对住院的影响，该模式为社区居住的非常虚弱的老年患者提供综合初级保健和强化病例管理。我们在巴黎市区对428名非常虚弱的患者进行了一项准实验研究（干预组105名，对照组323名），随访一年。主要结局指标为任何计划外住院（通过急诊科）、任何计划住院（直接入院，无急诊科就诊）和任何总体住院。次要结果测量包括用RAI-HC（居民评估工具-家庭护理）评估的健康参数。与对照组相比，干预组在一年内至少有一次计划外住院的风险降低，计划住院率增加，住院总人数没有显著变化。干预组患者出现抑郁和呼吸困难的风险较低。COPA模式通过减少计划外住院和改善某些健康参数，提高了向非常虚弱的老年患者提供的护理质量。2014爱思唯尔爱尔兰有限公司版权所有。
Very frail elderly patients living in the community, present complex needs and have a higher rate of hospital admissions with emergency department (ED) visits. Here, we evaluated the impact on hospital admissions of the COPA model (CO-ordination Personnes Agees), which provides integrated primary care with intensive case management for community-dwelling, very frail elderly patients. We used a quasi-experimental study in an urban district of Paris with four hundred twenty-eight very frail patients (105 in the intervention group and 323 in the control group) with one-year follow-up. The primary outcome measures were the presence of any unplanned hospitalization (via the ED), any planned hospitalizations (direct admission, no ED visit) and any hospitalization overall. Secondary outcome measures included health parameters assessed with the RAI-HC (Resident Assessment Instrument-Home Care). Comparing the intervention group with the control group, the risk of having at least one unplanned hospital admission decreased at one year and the planned hospital admissions rate increased, without a significant change in total hospital admissions. Among patients in the intervention group, there was less risk of depression and dyspnea. The COPA model improves the quality of care provided to very frail elderly patients by reducing unplanned hospitalizations and improving some health parameters. (C) 2014 Elsevier Ireland Ltd. All rights reserved.