CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients.
CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients.
复制标题
珍惜（住院老年人的合作，减少了住院的影响）：多站点改进计划的方案，以减少老年患者的老年综合症。
DOI：
10.1186/s12877-016-0399-7
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发表时间：
2017-01-09
期刊：
影响因子：
4.1
通讯作者：
Young AM
中科院分区：
文献类型：
--
作者：
Mudge AM;Banks MD;Barnett AG;Blackberry I;Graves N;Green T;Harvey G;Hubbard RE;Inouye SK;Kurrle S;Lim K;McRae P;Peel NM;Suna J;Young AM
老年住院患者有发生医院相关老年综合征的风险，包括谵妄、功能下降、尿失禁、福尔斯和压力损伤。这些导致住院时间延长，丧失独立性和死亡。有效的干预措施，以减少老年综合征仍然实施不力，由于其复杂性，并需要一个有组织的方法来改变护理实践和系统。Eat Walk Engage是一种结构化实施的复杂多组分干预，在一家医院的试点研究中显示出减少老年综合征和住院时间。本研究将使用多中心群集随机试验来测试实施Eat Walk Engage的有效性，以告知这种干预措施的可转移性。混合研究设计将评估Eat Walk Engage在现实世界环境中的有效性和实施策略。将在4家医院的8个内科和外科病房进行多中心群集随机研究，每个中心的一个病房随机实施Eat Walk Engage（干预），一个病房继续常规护理（对照）。干预病房将得到支持，以制定和实施适合当地情况的战略，以加强早期流动性，营养和有意义的活动。资源将包括一名经过培训的辅导员、审计支持、一名经过培训的医疗保健助理，以及一个使用i-PARIHS实施框架的专家辅导员团队的支持。干预前后的患者结局和过程测量将在干预病房和对照病房之间进行比较。主要结局是任何医院相关的老年综合征（谵妄、功能下降、福尔斯、压力损伤、新发失禁）和住院时间。次要结局包括出院目的地; 30天死亡率、功能和生活质量; 6个月再入院率;以及成本效益。包括患者访谈、活动规划和用餐时间审计在内的流程措施将为每个研究中心的干预措施提供信息，并衡量改善进展。将在执行病房监测影响执行成功轨迹的因素。CHERISH研究采用混合设计并在明确的实施框架指导下，将建立一个成功的试点计划的有效性、成本效益和可转移性，以改善老年住院患者的护理，并确定支持成功实施的功能。 ACTRN 12615000879561于2015年8月21日前瞻性注册。
Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention. A hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards. Using a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation. ACTRN12615000879561 registered prospectively 21/8/2015.