Implementing innovative models of dementia care: The Healthy Aging Brain Center
Implementing innovative models of dementia care: The Healthy Aging Brain Center
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DOI：
10.1080/13607863.2010.496445
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发表时间：
2011-01-01
影响因子：
3.4
通讯作者：
Callahan, Christopher M.
中科院分区：
文献类型：
--
作者：
Boustani, Malaz A.;Sachs, Greg A.;Callahan, Christopher M.
背景资料：最近的随机对照试验已经证明了合作痴呆症护理模式的有效性，该模式针对患有痴呆症的患者及其非正式照顾者。目的：在印第安纳波利斯的公共卫生保健系统中实施可持续的协作性痴呆症护理计划。研究方法：我们使用复杂适应系统的框架和反思适应过程的工具，将痴呆症护理试验的结果转化为健康老龄化脑中心（HABC）。结果：在运作的第一年内，HABC提供了528次访问，为208名患者和176名非正式护理人员提供服务。HABC患者的平均年龄为73.8岁（标准差，SD 9.5），40%为非洲裔美国人，42%的受教育程度低于高中，14%的认知状态正常，39%被诊断为轻度认知障碍，46%被诊断为痴呆。在首次HABC访视的12个月内，28%的患者至少去过一次急诊室（ER），14%的患者住院，平均住院时间为5天。1周急诊室再访率为14%，30天再住院率为11%。只有5%的HABC患者接受了抗精神病药物的订单，只有16%的患者同时接受了明确的抗胆碱能药物和抗痴呆药物的订单。结论：“实施科学”的工具可以用来翻译在研究实验室开发的医疗保健提供模式，以一个实用的，可操作的，医疗保健提供计划。
Background: Recent randomized controlled trials have demonstrated the effectiveness of the collaborative dementia care model targeting both the patients suffering from dementia and their informal caregivers. Objective: To implement a sustainable collaborative dementia care program in a public health care system in Indianapolis. Methods: We used the framework of Complex Adaptive System and the tool of the Reflective Adaptive Process to translate the results of the dementia care trial into the Healthy Aging Brain Center (HABC). Results: Within its first year of operation, the HABC delivered 528 visits to serve 208 patients and 176 informal caregivers. The mean age of HABC patients was 73.8 (standard deviation, SD 9.5), 40% were African-Americans, 42% had less than high school education, 14% had normal cognitive status, 39% received a diagnosis of mild cognitive impairment, and 46% were diagnosed with dementia. Within 12 months of the initial HABC visit, 28% of patients had at least one visit to an emergency room (ER) and 14% were hospitalized with a mean length of stay of five days. The rate of a one-week ER revisit was 14% and the 30-day rehospitalization rate was 11%. Only 5% of HABC patients received an order for neuroleptics and only 16% had simultaneous orders for both definite anticholinergic and anti-dementia drugs. Conclusion: The tools of 'implementation science' can be utilized to translate a health care delivery model developed in the research laboratory to a practical, operational, health care delivery program.