Identification and team-based interprofessional management of hospitalized vulnerable older adults
Identification and team-based interprofessional management of hospitalized vulnerable older adults
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DOI：
10.1016/j.outlook.2015.11.014
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发表时间：
2016-03-01
期刊：
影响因子：
4.3
通讯作者：
Braunstein, Glenn David
中科院分区：
文献类型：
--
作者：
Borenstein, Jeff Edward;Aronow, Harriet Udin;Braunstein, Glenn David
背景：住院时间延长和并发症在老年人中很常见，可能导致发病和丧失独立性。专门的老年科单位已被证明可以改善结果，但随着老年人数量的不断增加，可能难以扩大规模以满足需求。目的：目的是评估一项质量改进计划，该计划重新设计了基于单位的工作流程，并对普通医疗/外科单位的跨专业团队进行了培训，以使用综合老年评估和团队管理的原则为弱势老年人制定护理计划。方法：评估包括10个内科/外科单位的随机分组对照试验和符合风险筛选标准的所有患者的意向治疗分析。结果：N = 1，384，中位年龄= 80.9岁，53.5%为女性。观察与预期住院时间的平均差异短1.03天（p = 0.006）;并发症发生率（比值比[OR] = 0.45; 95%置信区间[CI] = 0.21-0.98）并转入重症监护室（OR = 0.45; 95%CI = 0.25-0.79）;出院至机构治疗的发生率较高（OR = 1.43; 95%CI = 1.06-1.93）。住院期间的死亡率（OR = 0.64; 95%CI = 0.37-1.11）并没有显着差异groups.Conclusion：重组一般医疗/外科单位，提供团队为基础的跨专业护理可以改善住院老年人的结果。
Background: Extended hospital stays and complications are common among older adults and may lead to morbidity and loss of independence. Specialized geriatric units have been shown to improve outcomes but, with the growing numbers of older adults, may be difficult to scale to meet needs.Purpose: The purpose was to evaluate a quality improvement initiative that redesigned unit-based workflow and trained interprofessional teams on general medical/surgical units to create care plans for vulnerable older adults using principles of comprehensive geriatric assessment and team management.Method: The evaluation included a cluster randomized controlled trial of 10 medical/surgical units and intention-to-treat analysis of all patients meeting risk screening criteria.Results: N = 1,384, median age = 80.9 years, and 53.5% female. Mean difference in observed vs. expected length of stay was 1.03 days shorter (p = .006); incidence of complications (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.21-0.98) and transfer to intensive care (OR = 0.45; 95% CI = 0.25-0.79) lower among patients admitted to intervention units; incidence of discharge to institutional care was higher (OR = 1.43; 95% CI = 1.06-1.93). Mortality during hospitalization (OR = 0.64; 95% CI = 0.37-1.11) did not differ between groups.Conclusion: Reorganizing general medical/surgical units to provide team-based interprofessional care can improve outcomes among hospitalized older adults.