The Effect of Guided Care Teams on the Use of Health Services Results From a Cluster-Randomized Controlled Trial
The Effect of Guided Care Teams on the Use of Health Services Results From a Cluster-Randomized Controlled Trial
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DOI：
10.1001/archinternmed.2010.540
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发表时间：
2011-03-14
影响因子：
--
通讯作者：
Scharfstein, Daniel O.
中科院分区：
文献类型：
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作者：
Boult, Chad;Reider, Lisa;Scharfstein, Daniel O.
背景资料：跨学科初级保健团队对多种慢性病患者使用卫生服务的影响尚不确定。本研究的目的是衡量多病老年患者的使用health services.Methods：从3个卫生保健系统在巴尔的摩，马里兰州，华盛顿特区，地区符合条件的患者进行群集随机接受指导护理或常规护理20个月之间的2006年11月1日，2008年6月30日的效果。由一名指导护理护士与患者的初级保健医生合作提供八项服务：全面评估、循证护理规划、每月监测症状和依从性、过渡性护理、协调保健专业人员、支持自我管理、支持家庭照顾者和加强社区服务。结果措施的使用频率的急诊科，医院，熟练的护理设施，家庭健康机构，初级保健医生服务，专科医生service.Results：这项研究包括850名老年患者在高风险的使用卫生保健严重的未来。在整个样本中，指导性护理的唯一统计学显著总体效果是减少了家庭医疗保健事件（比值比，0.70; 95%置信区间，0.530-0.93）。在预先计划的分析中，指导性护理也减少了熟练的护理设施入院（比值比，0.53; 95%置信区间，0.31-0.89）和天（0.48; 0.280-0.84）之间Kaiser Permanente patients.Conclusions：指导性护理减少了家庭医疗保健的使用，但在短期内对其他卫生服务的使用影响不大。它对Kaiser-Permanente患者使用专业护理设施和其他医疗服务的积极影响是耐人寻味的。试验注册：clinicaltrials.gov标识符：NCT 00121940
Background: The effect of interdisciplinary primary care teams on the use of health services by patients with multiple chronic conditions is uncertain. This study aimed to measure the effect of guided care teams on multimorbid older patients' use of health services.Methods: Eligible patients from 3 health care systems in the Baltimore, Maryland-Washington, DC, area were cluster-randomized to receive guided care or usual care for 20 months between November 1, 2006, and June 30, 2008. Eight services of a guided care nurse working in partnership with patients' primary care physicians were provided: comprehensive assessment, evidence-based care planning, monthly monitoring of symptoms and adherence, transitional care, coordination of health care professionals, support for self-management, support for family caregivers, and enhanced access to community services. Outcome measures were frequency of use of emergency departments, hospitals, skilled nursing facilities, home health agencies, primary care physician services, and specialty physician services.Results: The study included 850 older patients at high risk for using health care heavily in the future. The only statistically significant overall effect of guided care in the whole sample was a reduction in episodes of home health care (odds ratio, 0.70; 95% confidence interval, 0.530-0.93). In a preplanned analysis, guided care also reduced skilled nursing facility admissions (odds ratio, 0.53; 95% confidence interval, 0.31-0.89) and days (0.48; 0.280-0.84) among Kaiser-Permanente patients.Conclusions: Guided care reduces the use of home health care but has little effect on the use of other health services in the short run. Its positive effect on Kaiser-Permanente patients' use of skilled nursing facilities and other health services is intriguing.Trial Registration: clinicaltrials.gov Identifier: NCT00121940