Impact of the care coordination program "Partners in Dementia Care" onveterans' hospital admissions and emergency department visits.
Impact of the care coordination program "Partners in Dementia Care" onveterans' hospital admissions and emergency department visits.
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DOI：
10.1016/j.trci.2015.03.003
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发表时间：
2015-06-01
期刊：
影响因子：
--
通讯作者：
Kunik, Mark E
中科院分区：
文献类型：
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作者：
Bass, David M;Judge, Katherine S;Kunik, Mark E
简介：“痴呆症护理合作伙伴”（PDC）测试了一项基于退伍军人事务部（VA）医疗中心和阿尔茨海默氏症协会分会之间合作关系的护理协调计划。假设PDC将减少退伍军人的入院和急诊科（艾德）访问的可能性和数量，特别是对于那些有更多的认知障碍或行为symptoms.METHODS：样本包括328名退伍军人痴呆症和他们的主要家庭或朋友照顾者从五个匹配的网站（两个随机选择的治疗网站）。数据来自VA记录，并辅以护理人员研究访谈。回归分析使用的可能性和数量的医院和艾德访问的结果测试的整体治疗比较组的差异和统计相互作用与认知障碍和行为symptoms.RESULTS：与假设一致，三个显着的相互作用显示治疗组的退伍军人，更多的认知障碍和行为症状，有较少的住院和艾德访问比比较组的退伍军人。在医院或艾德use.Discussion的可能性没有差异：PDC，退伍军人和照顾者的低成本计划，是有效地减少住院和艾德访问的数量，但不是可能性。当照顾者报告退伍军人的症状更困难时，服务使用的减少更大，在没有PDC的情况下，退伍军人将面临成为高容量，高成本服务用户的风险。ClinicalTrials.gov
INTRODUCTION: "Partners in Dementia Care" (PDC) tested a care-coordination program based on partnerships between Veterans Affairs (VA) medical centers and Alzheimer's Association chapters. The hypothesis posited PDC would reduce the likelihood and number of veterans' hospital admissions and emergency department (ED) visits, particularly for those with more cognitive impairment or behavioral symptoms.METHODS: The sample included 328 veterans with dementia and their primary family or friend caregivers from five matched sites (two randomly selected treatment sites). Data came from VA records; supplemented by caregiver research interviews. Regression analyses using the likelihood and number of hospital and ED visits as outcomes tested for overall treatment-comparison group differences and statistical interactions with cognitive impairment and behavioral symptoms.RESULTS: Consistent with the hypothesis, three significant interactions showed treatment-group veterans, with more cognitive impairment and behavioral symptoms, had fewer hospital admissions and ED visits than comparison-group veterans. There were no differences in the likelihood of hospital or ED use.DISCUSSION: PDC, a low-cost program for veterans and caregivers, was effective in reducing the number, but not the likelihood, of hospital admissions and ED visits. Reductions in service use were greater when caregivers reported more difficulties with veterans' symptoms, which in the absence of PDC would place veterans at risk of being high-volume, high-cost service users.Clinical Trial Registration: ClinicalTrials.gov: NCT00291161.