Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model: ACCESS, an open-labelled randomised clinical trial of effectiveness.
Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model: ACCESS, an open-labelled randomised clinical trial of effectiveness.
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DOI：
10.1186/s13049-018-0492-3
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发表时间：
2018-04-05
期刊：
影响因子：
--
通讯作者：
Skjøt-Arkil H
中科院分区：
文献类型：
--
作者：
Mogensen CB;Ankersen ES;Lindberg MJ;Hansen SL;Solgaard J;Therkildsen P;Skjøt-Arkil H
家庭医院 (HaH) 是老年患者急性入院的替代方案。目前尚不清楚是否应主要由医院实习专家或患者自己的全科医生 (GP) 进行护理。该研究评估了基于全科医生的模式是否比基于医院专家的模式更有效地减少住院人数，而不影响患者的康复或死亡人数。这是一项务实、随机、开放标签的多中心平行组试验，在丹麦南部的四个城市、四个急诊室和 150 名全科医生中进行了两组试验，其中包括 65 岁以上患有急性疾病、需要紧急医院住院治疗的患者。患者被随机分配到基于医院专家的 HaH 护理模式或全科医生模式。在入组时和 7 天后进行了五项身体和认知表现测试。主要结果是 7 天内住院的人数。次要结果是 14、21 和 30 天内的入院人数、30 和 90 天内的死亡人数以及表现测试的变化。 67 名患者参加了全科医生模式，64 名患者参加了医院专科医生模式。医院专科组中有 45% 的患者在 7 天内入院，而全科医生组中有 24% 的患者在 7 天内入院（效应值 2.7，95% CI 1.3–5.8；p = 0.01），并且这一情况在 30 天内仍然显着。两组之间从第 0 天到第 7 天的死亡或性能测试变化没有发现差异。基于全科医生的 HaH 模型比医院专科模型更有效地避免患有急性疾病的老年患者在 7 天内入院，两种模型之间的精神或身体康复率或死亡率没有差异。编号：NCT02422849 2015 年 3 月 27 日注册。追溯注册
Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient’s own general practitioner (GP). The study assessed whether a GP based model was more effective than a hospital specialist based model at reducing number of hospital admissions without affecting the patient’s recovery or number of deaths. Pragmatic, randomised, open-labelled multicentre parallel group trial with two arms in four municipalities, four emergency departments and 150 GPs in Southern Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7 days. Primary outcome was number of hospital admissions within 7 days. Secondary outcomes were number of admissions within 14, 21 and 30 days, deaths within 30 and 90 days and changes in performance tests. Sixty seven patients were enrolled in the GP model and 64 in the hospital specialist model. 45% in the hospital specialist arm versus 24% in the GP arm were admitted within 7 days (effect size 2.7, 95% CI 1.3–5.8; p = 0.01) and this remained significant within 30 days. No differences were found in death or changes in performance tests from day 0–7 days between the two groups. The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models. No. NCT02422849 Registered 27 March 2015. Retrospectively registered
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影响因子：
6.7
作者：
Roberts, Helen C.;Syddall, Holly Emma;Sayer, Avan Aihie
通讯作者：
Sayer, Avan Aihie
从医院急性评估单位出院的患者的专业老年医学评估：随机对照试验。
DOI：
10.1136/bmj.f5874
发表时间：
2013-10-08
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Edmans J;Bradshaw L;Franklin M;Gladman J;Conroy S
通讯作者：
Conroy S
影响因子：
14.6
作者：
Shepperd, Sasha;Doll, Helen;Wilson, Andrew D.
通讯作者：
Wilson, Andrew D.
DOI：
10.1097/phm.0b013e31828cd2b6
发表时间：
2013-09-01
影响因子：
3
作者：
Bodilsen, Ann Christine;Pedersen, Mette Merete;Bandholm, Thomas
通讯作者：
Bandholm, Thomas
影响因子：
3.3
作者：
Cheng, Jennifer;Montalto, Michael;Leff, Bruce
通讯作者：
Leff, Bruce