Advance care planning and hospital in the nursing home
Advance care planning and hospital in the nursing home
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DOI：
10.1093/ageing/afl063
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发表时间：
2006-11-01
期刊：
影响因子：
6.7
通讯作者：
Willett, Wendy
中科院分区：
文献类型：
--
作者：
Caplan, Gideon A.;Meller, Anne;Willett, Wendy
背景资料：护理之家居民（NHRs）在医院的数量正在增加，虽然入院可能是有害的，他们的health.Objective：评估教育居民，他们的家庭，工作人员和全科医生有关痴呆症的结果，提前护理计划（ACP）和医院在home.Methods：我们聘请了一名临床护士顾问，谁利用了'让我决定'提前护理指令。干预区包括两个医院和21个疗养院（NHs）与另一个，地理上分开，医院和13个家庭周围it. We进行了一个控制评估监测急诊入院hospital.Results：紧急呼叫救护车服务从干预NHs减少（干预与对照; -1对+21%; P = 0.0019）。与对照医院病床相比，每个NH病床上的居民在干预医院病床上呆一天的风险降低了四分之一，从最初的相似[相对风险（RR）= 1.01; 95%置信区间（CI）0.98 - 1.04; P = 0.442]降至更低（RR = 0.74; 95% CI 0.72 - 0.77; P < 0.0001）。干预后第3年死亡率无明显变化，但对照组第3年死亡率上升，为11.2/100床，高于干预区（P < 0.05）。结论：ACP和家庭住院可降低NHR的住院率和死亡率。
Background: the number of nursing home residents (NHRs) in hospital is increasing although hospital admission may be deleterious to their health.Objective: to evaluate a system of educating residents, their families, staff and general practitioners about outcomes of dementia, advance care planning (ACP) and hospital in the home.Methods: we employed one clinical nurse consultant, who utilised the 'Let Me Decide' Advance Care Directive. The intervention area consisted of two hospitals and the 21 nursing homes (NHs) around them compared with another, geographically separate, hospital and the 13 homes around it. We conducted a controlled evaluation monitoring emergency admissions to hospital.Results: emergency calls to the ambulance service from intervention NHs decreased (intervention versus control; -1 versus +21 %; P = 0.0019). The risk of a resident being in an intervention hospital bed for a day compared with in a control hospital bed, per NH bed, fell by a quarter from being initially similar [Relative Risk (RR) = 1.01; 95 % confidence interval (CI) 0.98 - 1.04; P = 0.442] to being lower (RR = 0.74; 95 % CI 0.72 - 0.77; P < 0.0001). There was no significant change in mortality in the intervention homes, but in the control homes mortality rose in the third year to be 11.2 per 100 beds higher than in the intervention area (P < 0.05).Conclusion: ACP and hospital in the home can result in decreased hospital admission and mortality of NHRs.