A randomized clinical trial of outpatient geriatric evaluation and management
A randomized clinical trial of outpatient geriatric evaluation and management
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DOI：
10.1046/j.1532-5415.2001.49076.x
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发表时间：
2001-04-01
影响因子：
6.3
通讯作者：
Urdangarin, CF
中科院分区：
文献类型：
--
作者：
Boult, C;Boult, LB;Urdangarin, CF
目的：为了测量门诊老年评估和管理（GEM）对高危老年人的功能能力和卫生服务使用的影响，设计：随机临床试验。设置：社区医院的门诊诊所。参与者：以人口为基础的样本，年龄70岁及以上的社区居住医疗保险受益人，他们未来住院的风险很高（N = 568）。干预：综合评估，其次是跨学科的初级care. Measures：功能能力，活动受限的日子，卧床残疾的日子，抑郁症状，死亡率，医疗保险支付，并使用卫生服务。访谈者对参与者的群体状态不知情。意向治疗分析显示，实验参与者丧失功能能力的可能性明显低于对照组（调整后的比值比（aOR）= 0.67，95%置信区间（CI）= 0.47-0.99），在日常活动中经历更多的健康相关限制（aOR = 0.60，95%CI = 0.37-0.96），可能患有抑郁症（aOR = 0.44，95%CI = 0.20-0.94），或在随机化后12 - 18个月内使用家庭医疗服务（aOR = 0.60，95%CI = 0.37-0.92）。死亡率，大多数医疗服务的使用，和总的医疗保险支付两组之间没有显着差异。每人的干预费用为1，350美元。结论：有针对性的门诊GEM减缓了功能衰退。
OBJECTIVES: To measure the effects of outpatient geriatric evaluation and management (GEM) on high-risk older persons' functional ability and use of health services.DESIGN: Randomized clinical trial.SETTING: Ambulatory clinic in a community hospital.PARTICIPANTS: A population-based sample of community-dwelling Medicare beneficiaries age 70 and older who were at high risk for hospital admission in the future (N = 568).INTERVENTION: Comprehensive assessment followed by interdisciplinary primary care.MEASUREMENTS: Functional ability, restricted activity days, bed disability days, depressive symptoms, mortality, Medicare payments, and use of health services. Interviewers were blinded to participants' group status.RESULTS: Intention-to-treat analysis showed that the experimental participants were significantly less likely than the controls to lose functional ability (adjusted odds ratio (aOR) = 0.67, 95% confidence interval (CI) = 0.47-0.99), to experience increased health-related restrictions in their daily activities (aOR = 0.60, 95% CI = 0.37-0.96), to have possible depression (aOR = 0.44, 95% CI = 0.20-0.94), or to use home healthcare services (aOR = 0.60, 95% CI = 0.37-0.92) during the 12 to 18 months after randomization. Mortality, use of most health services, and total Medicare payments did not differ significantly between the two groups. The intervention cost $1,350 per person.CONCLUSION: Targeted outpatient GEM slows functional decline.