The Role of an Acute Care for the Elderly Unit in Achieving Hospital Quality Indicators While Caring for Frail Hospitalized Elders
The Role of an Acute Care for the Elderly Unit in Achieving Hospital Quality Indicators While Caring for Frail Hospitalized Elders
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DOI：
10.1089/pop.2011.0055
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发表时间：
2012-08-01
影响因子：
2.5
通讯作者：
Dyer, Carmel B.
中科院分区：
文献类型：
--
作者：
Ahmed, Nasiya;Taylor, Kimberlee;Dyer, Carmel B.
老年人急性护理(ACE)单位成功地降低了住院时间、住院费用和再住院率。此外，患者回国后功能能力增强，住院满意度提高。ACE单元的概念是面向恢复独立生活的患者，但平均住院的老年患者越来越虚弱、脆弱和依赖。这项研究的目的有两个：(1)确定ACE单元是否继续为虚弱的、经常卧床的老年人提供同样的好处，以及(2)确定这样的单元是否能够维持标准的医院质量指标。将2008年7月至2010年6月期间从纪念-赫尔曼ACE单元出院的1096例患者与2007年7月至2008年6月期间出院的383名具有类似病情的患者样本进行了比较。测量的指标包括：平均住院时间(ALOS)、病例组合指数(CMI)、病例组合调整后的平均住院时间(CMI Adj ALOS)、每个病例的平均直接成本和再住院率。患者满意度使用医疗保健提供者和系统的医院消费者评估和Press-Caney调查进行衡量；质量和安全数据由纪念-Herrnann的质量和安全部提供。ACE单位导致ALOS和CMI调整LOS在统计上显著下降，而卫生保健融资管理局CMI同时增加，表明该单位服务的是更多病情更弱的人口。再住院率为11.95%。住院时间、再住院率和直接费用的减少转化为每个病例费用的减少。此外，ACE单位成功地达到了医院质量指标。(《人口健康管理》2012；15：236-240)
Acute Care for the Elderly (ACE) units have successfully decreased length of stay, hospital costs, and readmission rates. Furthermore, patients return home with increased functional capacity and improved satisfaction with their hospital stay. The ACE unit concept was geared toward patients returning to independent living, but the average hospitalized geriatric patient is increasingly more frail, vulnerable, and dependent. The purpose of this study is 2-fold: (1) to determine if the ACE unit continues to offer the same benefit to the frail, often bedbound elderly, and (2) to determine if such a unit is able to maintain standard hospital quality indicators. A total of 1096 cases discharged from the Memorial-Hermann ACE unit between July 2008 and June 2010 were compared to a sample of 383 patients with similar illness severity who were discharged between July 2007 and June 2008. Metrics measured include: average length of stay (ALOS), case mix index (CMI), case mix adjusted average length of stay (CMI adj ALOS), average direct costs per case, and readmission rate. Patient satisfaction was measured using Hospital Consumer Assessment of Healthcare Providers and Systems and Press-Caney surveys; quality and safety data were provided by Memorial-Herrnann's Quality and Safety Department. The ACE unit resulted in a statistically significant decrease in ALOS and CMI adj LOS with a simultaneous increase in Health Care Financing Administration CMI, indicating that the unit was serving a sicker, more frail population. The readmission rate was 11.95%. The decrease in length of stay, readmission rate, and direct cost translates into a decrease in cost per case. Furthermore, the ACE unit successfully met hospital quality indicators. (Population Health Management 2012;15:236-240)