Organizational interventions to improve health outcomes of older persons
Organizational interventions to improve health outcomes of older persons
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DOI：
10.1097/00005650-200205000-00007
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发表时间：
2002-05-01
期刊：
影响因子：
3
通讯作者：
Reuben, DB
中科院分区：
文献类型：
--
作者：
Reuben, DB
背景随着保健筹资的重组和护理系统的建立，有可能设计和实施组织干预措施，以改善对老年人的护理，而不仅仅是个人提供者所能提供的服务。审查老年人的组织干预措施的有效性，描述成功模式传播到实践环境中的障碍，并确定这种干预措施的未来方向。选择性回顾主要针对老年人群的组织干预措施，并使用常规研究设计（通常为随机临床试验）进行正式评估。组织干预可以分为两组：组件模型和系统的变化。前者可以叠加在一个完整的系统之上，但不会从根本上改变护理系统，而后者则改变了基层护理的基本结构。各种各样的组织干预措施已在不同的环境中实施，但支持这些干预措施的有效性的证据是不一致的。即使这些干预措施在研究环境中有效，这些干预措施也很少减少医疗保健费用。此外，在将成功的干预措施付诸实践方面存在着巨大的障碍。组织干预是影响保健和维持老年人健康状况的潜在有力方法。然而，知识与实践之间的差距以及关于组织干预措施的有效性的未回答的问题，目前限制了这一方法在改善老年人保健方面的潜在价值。
BACKGROUND. With the reorganization of the financing of health care and creation of systems of care, it is possible to design and implement organizational interventions to improve the care of older persons beyond the services that can be provided by an individual provider.OBJECTIVES. To review the effectiveness of organizational interventions for older persons, describe barriers to dissemination of success models into practice settings, and identify future directions for such interventions.METHODS. Selective review of organizational interventions that have been aimed primarily at the geriatric population and have been formally evaluated using conventional research designs, usually randomized clinical trials.RESULTS. Organizational interventions can be classified into two groups: component models and systems changes. The former can be superimposed upon an intact system but do not fundamentally change the system of care whereas the latter modify the basic structure of primary care. A variety of organizational interventions have been implemented in diverse settings, but the evidence supporting the effectiveness of these interventions is inconsistent. Even when such interventions have been effective in research settings, these interventions rarely reduce health care costs. Moreover, there have been formidable barriers to implementation of successful interventions into practice.CONCLUSIONS. Organizational interventions are potentially powerful methods to influence health care and maintain health status of older persons. Nevertheless, gaps between knowledge and practice and unanswered questions about the effectiveness of organizational interventions currently limit the potential value of this approach to improving health care of older persons.