Early effects of "Guided care" on the quality of health care for multimorbid older persons: A cluster-randomized controlled trial
Early effects of "Guided care" on the quality of health care for multimorbid older persons: A cluster-randomized controlled trial
复制标题
DOI：
10.1093/gerona/63.3.321
复制
发表时间：
2008-03-01
影响因子：
5.1
通讯作者：
Scharfstein, Daniel
中科院分区：
文献类型：
--
作者：
Boult, Chad;Reider, Lisa;Scharfstein, Daniel
背景。患有多种慢性疾病的美国老年人的医疗保健质量是次优的。我们设计了“指导护理”（GC），通过将一名在慢性护理方面受过强化培训的注册护士纳入初级保健实践，与医生一起为50-60名患有多种疾病的老年患者提供全面的慢性护理，从而提高护理质量。我们假设GC可以改善该人群的医疗保健质量。2006年，我们在8个诊所（n = 49名医生）开始了GC的集群随机对照试验。这些做法的老年患者如果在来年有大量使用保健服务的风险，则有资格参加。由2 - 5名医生和他们的高危老年患者组成的小组被随机分配到GC或常规护理（UC）组。基线后六个月，参与者通过回答电话采访者提出的有效的封闭式问题来评价他们的医疗质量。在筛选的13534例老年患者中，2391例（17.7%）符合参加研究的条件，其中904例（37.8%）给予知情同意，并进行集群随机化。6个月后，93.8%和93.2%的GC和UC参与者完成了电话访谈。GC参与者比UC参与者更有可能对他们的护理给予高度评价（调整优势比= 2.0,95%置信区间，1.2-3.4,p = 0.006），初级保健医生更有可能对他们与慢性老年患者及其家属的互动感到满意(p
Background. The quality of health care for older Americans with multiple chronic conditions is suboptimal. We designed "Guided Care" (GC) to enhance quality of care by integrating a registered nurse, intensively trained in chronic care, into primary care practices to work with physicians in providing comprehensive chronic care to 50-60 multimorbid older patients.Methods. We hypothesized that GC would improve the quality of health care for this Population. In 2006, we began a cluster-randomized controlled trial of GC at eight practices (n = 49 physicians). Older patients of these practices were eligible to participate if they were at risk for using health services heavily during the coming year. Teams of two to five physicians and their at-risk older patients were randomized to either GC or usual care (UC). Six months after baseline, participants rated the quality of their health care by answering validated closed-ended questions from telephone interviewers who were masked to group assignment.Results. Of the 13,534 older patients screened, 2391 (17.7%) were eligible to participate in the study, of which 904 (37.8%) gave informed consent and were cluster-randomized. After 6 months, 93.8% and 93.2% of the GC and UC participants who remained alive and eligible completed telephone interviews. GC participants were more likely than UC participants to rate their care highly (adjusted odds ratio = 2.0, 95% confidence interval, 1.2-3.4, p = .006), and primary care physicians were more likely to be satisfied with their interactions with chronically ill older patients and their families (p