The Effects of Guided Care on the Perceived Quality of Health Care for Multi-morbid Older Persons: 18-Month Outcomes from a Cluster-Randomized Controlled Trial
The Effects of Guided Care on the Perceived Quality of Health Care for Multi-morbid Older Persons: 18-Month Outcomes from a Cluster-Randomized Controlled Trial
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DOI：
10.1007/s11606-009-1192-5
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发表时间：
2010-03-01
影响因子：
5.7
通讯作者：
Boult, Chad
中科院分区：
文献类型：
--
作者：
Boyd, Cynthia M.;Reider, Lisa;Boult, Chad
背景技术：美国老年慢性病患者的医疗保健质量是次优的。目的：评估“引导式护理”对患者报告的慢性病护理质量的影响。设计：在14个初级保健团队中进行引导式护理的随机对照试验。参与者：如果根据对这些团队最近保险索赔的分析，他们有可能在未来一年承担高额的保健费用。小组医生和他们的风险老年患者被随机接受指导护理（GC）或常规护理（UC）。干预：“指导护理”旨在通过将接受过慢性病护理培训的注册护士整合到初级护理实践中，与2-5名医生合作，为50-60名患有多种疾病的老年患者提供全面的慢性病护理，从而提高医疗保健质量。基线后18个月，对分组不知情的访谈者通过电话进行慢性病护理患者评估（PACIC）调查。Logistic和线性回归被用来评估干预措施对慢性病护理质量的影响。结果：在筛选的13,534例老年患者中，2,391例（17.7%）有资格参加本研究，其中904例（37.8%）给予了知情同意书，并进行了随机分组。18个月后，95.3%和92.2%的GC和UC接受者仍然活着，并且符合条件。与UC受者相比，GC受者对他们的慢性护理的评价高两倍（aOR = 2.13，95%CI = 1.30-3.50，p = 0.003）。结论：引导护理提高了多病老年人自我报告的慢性医疗保健质量。
BACKGROUND: The quality of health care for older Americans with chronic conditions is suboptimal.OBJECTIVE: To evaluate the effects of "Guided Care" on patient-reported quality of chronic illness care.DESIGN: Cluster-randomized controlled trial of Guided Care in 14 primary care teams.PARTICIPANTS: Older patients of these teams were eligible to participate if, based on analysis of their recent insurance claims, they were at risk for incurring high health-care costs during the coming year. Small teams of physicians and their at-risk older patients were randomized to receive either Guided Care (GC) or usual care (UC).INTERVENTION: "Guided Care" is designed to enhance the quality of health care by integrating a registered nurse, trained in chronic care, into a primary care practice to work with 2-5 physicians in providing comprehensive chronic care to 50-60 multi-morbid older patients.MEASUREMENTS: Eighteen months after baseline, interviewers blinded to group assignment administered the Patient Assessment of Chronic Illness Care (PACIC) survey by telephone. Logistic and linear regression was used to evaluate the effect of the intervention on patient-reported quality of chronic illness care.RESULTS: Of the 13,534 older patients screened, 2,391 (17.7%) were eligible to participate in the study, of which 904 (37.8%) gave informed consent and were cluster-randomized. After 18 months, 95.3% and 92.2% of the GC and UC recipients who remained alive and eligible completed interviews. Compared to UC recipients, GC recipients had twice greater odds of rating their chronic care highly (aOR = 2.13, 95% CI = 1.30-3.50, p = 0.003).CONCLUSION: Guided Care improves self-reported quality of chronic health care for multi-morbid older persons.