Clinical Outcomes of Aging in Place
Clinical Outcomes of Aging in Place
复制标题
原地老龄化的临床结果
作者：
K. Marek;L. Popejoy;G. Petroski;D. Mehr;M. Rantz;Wen
医疗补助家庭和社区服务（HCBS）等项目通过社区长期护理服务为制度化提供了另一种选择；然而，与养老院（NH）居民相比，这些项目参与者的临床结果研究有限。目的比较以社区为基础的长期护理项目中个体的临床结果与以机构为基础的长期护理中相似病例组合的个体的临床结果。方法辛克莱护理学院与密苏里州HCBS项目合作开发了一个名为“原地老龄化”（AIP）的项目。AIP干预包括护士协调HCBS计划和医疗保险家庭健康服务。共有78名AIP参与者与78名NH居民在入院时间，日常生活活动（ADLs），认知状况和年龄方面进行匹配。最小数据集（MDS）在入院时收集，每6个月收集一次，为期30个月。认知用MDS认知表现量表（CPS）测量，ADL用5个MDS ADL项目的总和测量，抑郁用MDS抑郁评定量表测量，失禁用与尿失禁相关的2个MDS项目评定。采用Cochran-Mantel-Haenszel方法检验AIP干预与临床结果的相关性。结果AIP组临床疗效优于对照组，差异有统计学意义（p < 0.05）。(a) 6、12和18个月时的认知能力（p = .00）；(b) 6个月和12个月时抑郁（p = .00）；(c) 6 （p = .02）、12 （p = .04）和24 （p = .00）个月的ADL；(d) 24个月时尿失禁（p = 0.02）。在所有4项结果测量中，AIP组的结果评分稳定或改善，而NH组的结果评分恶化。讨论研究结果表明，社区护理与护士协调可提高长期护理参与者的临床结果。
BackgroundPrograms such as Medicaid Home and Community-based Services (HCBS) have provided an alternative to institutionalization through community-based, long-term care services; however, there are limited studies on the clinical outcomes of participants in these programs as compared to nursing home (NH) residents. ObjectiveTo compare clinical outcomes of individuals in a community-based, long-term care program to individuals of similar case mix in institutional-based, long-term care. MethodsA program called Aging in Place (AIP) was developed by the Sinclair School of Nursing in cooperation with the state of Missouri's HCBS program. The AIP intervention consisted of nurse coordination of the HCBS program and Medicare home health services. A total of 78 AIP participants were matched with 78 NH residents on admission period, activities of daily living (ADLs), cognitive status, and age. The Minimum Data Set (MDS) was collected on the AIP group at admission and every 6 months over a 30-month period. Cognition was measured by the MDS Cognitive Performance Scale (CPS), ADLs by the sum of 5 MDS ADL items, depression by the MDS-Depression Rating Scale, and incontinence by rating on 2 MDS items related to urinary continence. The Cochran–Mantel–Haenszel method was used to test the association between the AIP intervention and clinical outcomes. ResultsThe AIP group clinical outcomes were better at a statistically significant level (less than .05) for the following outcomes: (a) cognition at 6, 12, and 18 months (p = .00); (b) depression at 6 and 12 months (p = .00); (c) ADL at 6 (p = .02), 12 (p = .04), and 24 (p = .00) months; and (d) incontinence at 24 (p = .02) months. In all 4 outcome measures, the AIP group stabilized or improved outcome scores whereas the NH group's outcome scores deteriorated. DiscussionStudy results suggest that community-based care with nurse coordination enhances clinical outcomes of long-term care participants.
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影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
DOI：
10.1001/jama.1989.03430180093036
发表时间：
1989-11-10
影响因子：
120.7
作者：
EVANS, DA;FUNKENSTEIN, H;TAYLOR, JO
通讯作者：
TAYLOR, JO
疗养院居民的疼痛轨迹。
影响因子：
6.3
作者：
Cole,ConnieS;Carpenter,JanetS;Blackburn,Justin;Chen,ChenX;Jones,BobbyL;Hickman,SusanE
通讯作者：
Hickman,SusanE
影响因子：
120.7
作者：
Tinetti, ME;Baker, D;O'Leary, J
通讯作者：
O'Leary, J