Supported Discharge Teams for older people in hospital acute care: a randomised controlled trial
Supported Discharge Teams for older people in hospital acute care: a randomised controlled trial
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DOI：
10.1093/ageing/afx169
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发表时间：
2018-03-01
期刊：
影响因子：
6.7
通讯作者：
Kenealy, Tim
中科院分区：
文献类型：
--
作者：
Parsons, Matthew;Parsons, John;Kenealy, Tim
背景：支持出院团队旨在帮助从医院到家庭的过渡，同时减少住院时间。尽管他们明显的吸引力，证据仍然是混合的，从疾病特异性干预的有力支持到通用service.Objective不太有利的结果，以确定老年人转介到支持出院团队是否有：（i）减少住院时间;（ii）减少再入院的风险;（iii）减少医疗费用。方法：随机对照试验，随访6个月; 103名老年女性和80名男性（n = 183）（平均年龄79岁），住院，随机接受支持出院团队或常规护理。在注册护士、专职医疗和老年病医生的指导下，由经过培训的医疗助理提供为期6周的居家康复服务，每天最多4次，每周7天。随机分配到支持出院团队的参与者在索引入院期间住院时间更短（平均15.7天）与常规护理（平均21.6天）相比（平均差异5.9：95% CI 0.6，11.3天：P = 0.03），出院后6个月住院时间更短。支持出院组的费用计算平均新西兰元10,836（标准差新西兰元12,087）相比，新西兰元16,943（标准差新西兰元22,303）在usual care.Conclusion：支持出院团队可以提供一种有效的手段，出院的老年人从医院回家早，可以作出具有成本效益的贡献，以管理日益增长的需求，医院病床。
Background: Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services.Objective: To determine whether older people referred to a Supported Discharge Team have: (i) reduced length-of-stay in hospital; (ii) reduced risk of hospital readmission; and (iii) reduced healthcare costs.Methods: Randomised controlled trial with follow-up to 6 months; 103 older women and 80 men (n = 183) (mean age 79), in hospital, were randomised to receive either Supported Discharge Team or usual care. Home-based rehabilitation was delivered by trained Health Care Assistants up to four times a day, 7 days a week, under the guidance of registered nurses, allied health and geriatricians for up to 6 weeks.Results: Participants randomised to the Supported Discharge Team spent less time in hospital during the index admission (mean 15.7 days) in comparison to usual care (mean 21.6 days) (mean difference 5.9: 95% CI 0.6, 11.3 days: P = 0.03) and spent less time in hospital in the 6 months following discharge home. Supported discharge group costs were calculated at mean NZ$10,836 (SD NZ$12,087) compared to NZ$16,943 (SD NZ$22,303) in usual care.Conclusion:A Supported Discharge Team can provide an effective means of discharging older people home early from hospital and can make a cost-effective contribution to managing increasing demand for hospital beds.