Acute care models for older people living with frailty: a systematic review and taxonomy.
Acute care models for older people living with frailty: a systematic review and taxonomy.
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DOI：
10.1186/s12877-023-04373-4
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发表时间：
2023-12-05
期刊：
影响因子：
4.1
通讯作者：
Sapey, Elizabeth
中科院分区：
文献类型：
--
作者：
Knight, Thomas;Kamwa, Vicky;Atkin, Catherine;Green, Catherine;Ragunathan, Janahan;Lasserson, Daniel;Sapey, Elizabeth
改善急性护理路径以满足体弱老年人的护理需求是许多医疗保健系统的战略优先事项。该患者群体的最佳护理模式尚不清楚。进行了系统的审查，以获得急性医疗疾病的老年人的急性护理模式的分类，并描述了用于评估其有效性的结果。护理模式提供的时间有限的事件的护理（最多14天）在48小时内介绍给65岁以上的急性内科疾病的患者。基于医院和社区环境的护理模式符合条件。检索Medline、Embase、CINAHL和科克伦数据库。使用复杂干预的TIDIeR检查表的修改版本详细描述和分类干预。使用有效性试验中的核心结局指标（COMET）分类法对结局进行描述和分类。使用RoB 2和ROBINS-I评估偏倚风险。103篇文章符合纳入标准。确定了四类急性护理模式，即基于急性床的护理、家庭医院、急诊科接触和护理之家模式。该领域主要是小型单中心随机和非随机研究。大多数研究被认为有偏倚的风险。报告了一系列结局指标，研究之间几乎没有一致性。有效性的证据有限。急性护理模式的老年人生活与脆弱是异质性的。根据现有证据，无法最终确定这些模型的临床有效性。PROSPERO注册（CRD 42021279131）。在线版本包含补充材料，可通过10.1186/s12877-023-04373-4获得。
The need to improve the acute care pathway to meet the care needs of older people living with frailty is a strategic priority for many healthcare systems. The optimal care model for this patient group is unclear. A systematic review was conducted to derive a taxonomy of acute care models for older people with acute medical illness and describe the outcomes used to assess their effectiveness. Care models providing time-limited episodes of care (up to 14 days) within 48 h of presentation to patients over the age of 65 with acute medical illness were included. Care models based in hospital and community settings were eligible. Searches were undertaken in Medline, Embase, CINAHL and Cochrane databases. Interventions were described and classified in detail using a modified version of the TIDIeR checklist for complex interventions. Outcomes were described and classified using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Risk of bias was assessed using RoB2 and ROBINS-I. The inclusion criteria were met by 103 articles. Four classes of acute care model were identified, acute-bed based care, hospital at home, emergency department in-reach and care home models. The field is dominated by small single centre randomised and non-randomised studies. Most studies were judged to be at risk of bias. A range of outcome measures were reported with little consistency between studies. Evidence of effectiveness was limited. Acute care models for older people living with frailty are heterogenous. The clinical effectiveness of these models cannot be conclusively established from the available evidence. PROSPERO registration (CRD42021279131). The online version contains supplementary material available at 10.1186/s12877-023-04373-4.
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DOI：
10.1186/s13049-018-0492-3
发表时间：
2018-04-05
期刊：
Scandinavian journal of trauma, resuscitation and emergency medicine
影响因子：
--
作者：
Mogensen CB;Ankersen ES;Lindberg MJ;Hansen SL;Solgaard J;Therkildsen P;Skjøt-Arkil H
通讯作者：
Skjøt-Arkil H
影响因子：
6.3
作者：
Cai, Shubing;Grubbs, Andrew;Intrator, Orna
通讯作者：
Intrator, Orna
影响因子：
3.8
作者：
Crilly, Julia;Chaboyer, Wendy;Wallis, Marianne
通讯作者：
Wallis, Marianne
影响因子：
4.2
作者：
Crilly, Julia;Chaboyer, Wendy;Polit, Denise
通讯作者：
Polit, Denise
影响因子：
2.7
作者：
Abdalla, Ahmed;Adhaduk, Mehul;Bachuwa, Ghassan
通讯作者：
Bachuwa, Ghassan