Meals Enhancing Nutrition After Discharge: Findings from a Pilot Randomized Controlled Trial
Meals Enhancing Nutrition After Discharge: Findings from a Pilot Randomized Controlled Trial
复制标题
DOI：
10.1016/j.jand.2016.11.005
复制
发表时间：
2017-04-01
影响因子：
4.8
通讯作者：
Locher, Julie L.
中科院分区：
文献类型：
--
作者：
Buys, David R.;Campbell, Anthony D.;Locher, Julie L.
背景老年人在经历了健康状况不佳或住院后，他们可能不会回到病前或住院前的饮食行为。此外，营养不良会增加再次住院的风险，但针对这些风险的循证干预措施是有限的。目的：这项初步研究的目的是评估一项随机对照试验的可行性，评估出院后家庭送餐计划对老年人营养摄入和再次住院的影响，并评估患者对该计划的可接受性和满意度。这项研究的目的是评估24名参与者中至少80%的成功招募、随机和保留；比较干预组和对照组参与者再次住院的结果和每日总卡路里摄入量；并评估患者对该计划的可接受性和满意度。设计本研究采用双臂随机对照试验设计，在登记时收集基线数据；在干预期间收集三次24小时食物召回；并在出院后45天评估卫生服务利用和干预满意度。参与者来自阿拉巴马大学伯明翰医院急性老年护理单元(ACE)的24名患者，时间为2014年5月至2015年6月。他们年龄在65岁或以上；有营养不良的风险；认知完好；能够沟通；出院到患者或家人负责准备食物的地方；并被诊断为充血性心力衰竭、慢性阻塞性肺疾病、急性心肌梗死或肺炎。干预组接受为期10天的家庭送餐和营养教育；对照组接受常规护理和营养教育。主要结果指标主要结果是干预的可行性，以招募和保留目标来衡量。还评估了再次住院、卡路里摄入量和对干预的满意度。统计分析使用单变量和双变量参数统计来评估组之间的差异。确定成功的目标来评估进行全面研究的可行性，并对照这些目标来衡量结果。结果在随机的参与者中，87.5%的人被保留用于最终的数据收集，表明这项干预研究是可行的。在再次住院方面，两组之间没有显著差异；然而，干预组与对照组相比，干预期间的卡路里摄入量更大(1,595比1,235；P=0.03)。参与者对工作人员的工作表现、餐饮质量和送餐流程非常满意(82%至100%满意或非常满意)。结论与一家小型非营利性组织合作，开展一项随机对照试验，评估出院后为老年人提供家庭送餐的结果是可行的，并值得进一步研究。
Background After older adults experience episodes of poor health or are hospitalized, they may not return to premorbid or prehospitalization eating behaviors. Furthermore, poor nutrition increases hospital readmission risk, but evidence-based interventions addressing these risks are limited.Objective This pilot study's objective was to evaluate the feasibility of conducting a randomized controlled trial assessing a post-discharge home-delivered meal program's impact on older adults' nutritional intake and hospital readmissions and to assess patient acceptability and satisfaction with the program. The aims of the study were to evaluate successful recruitment, randomization, and retention of at least 80% of the 24 participants sought; to compare the outcomes of hospital readmission and total daily caloric intake between participants in the intervention and control groups; and to assess patient acceptability and satisfaction with the program.Design This study used a two-arm randomized controlled trial design, and baseline data were collected at enrollment; three 24-hour food recalls were collected during the intervention period; and health services utilization and intervention satisfaction was evaluated 45 days post-discharge.Participants/setting Twenty-four patients from the University of Alabama at Birmingham Hospital's Acute Care for Elders (ACE) Unit were enrolled from May 2014 to June 2015. They were 65 years or older; at risk for malnutrition; cognitively intact; able to communicate; discharged to a place where the patient or family was responsible for preparing meals; and diagnosed with congestive heart failure, chronic obstructive pulmonary disease, acute myocardial infarction, or pneumonia. Final analysis included 21 participants.Intervention The intervention group received 10 days of home-delivered meals and nutrition education; the control group received usual care and nutrition education.Main outcome measures The main outcome was intervention feasibility, measured by recruitment and retention goals. Hospital readmissions, caloric intake, and satisfaction with the intervention were also evaluated.Statistical analyses performed Univariate and bivariate parametric statistics were used to evaluate differences between groups. Goals for success were identified to assess feasibility of conducting a full-scale study and outcomes were measured against the goals.Results Of the randomized participants, 87.5% were retained for final data collection, indicating that this intervention study is feasible. There were no significant differences between groups for hospital readmissions; however, caloric intake during the intervention period was greater for intervention vs control participants (1,595 vs 1,235; P=0.03). Participants were overwhelmingly satisfied (82% to 100% satisfied or very satisfied) with staff performance, meal quality, and delivery processes.Conclusions Conducting a randomized controlled trial to assess outcomes of providing home-delivered meals to older adults after hospital discharge in partnership with a small nonprofit organization is feasible and warrants future research.