Quality of life of individuals with heart failure - A randomized trial of the effectiveness of two models of hospital-to-home transition
Quality of life of individuals with heart failure - A randomized trial of the effectiveness of two models of hospital-to-home transition
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DOI：
10.1097/00005650-200204000-00003
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发表时间：
2002-04-01
期刊：
影响因子：
3
通讯作者：
Graham, ID
中科院分区：
文献类型：
--
作者：
Harrison, MB;Browne, GB;Graham, ID
背景。充血性心力衰竭患者数量的不断增加增加了医院资源的压力和社区管理该疾病的需求。改善这一人群从医院到家庭的过渡是响应当前实践指南关于协调和教育的建议的合理步骤。评估多种干预措施、提高出院率以及通过增加病例管理角色进行随访的试验报告了积极的结果。问题仍然是，与普通的医院和社区护士合作是否可以取得类似的成果。方法。进行了一项为期 12 周的前瞻性随机对照试验，研究过渡护理对健康相关生活质量（特定疾病和一般措施）、再入院率和急诊室使用的影响。护士主导的干预措施侧重于从医院到家庭的过渡以及出院后 2 周自我管理的支持性护理。结果。出院后 6 周时，过渡护理患者的明尼苏达心力衰竭生活问卷 (MLHFQ) 总体评分 (27.2 +/- 19.1 SD) 优于常规护理患者 (37.5 +/- 20.3 SD；P = 0.002)。出院后 12 周的整体 MLHFQ 以及出院后 6 周和 12 周的 MLHFQ 身体维度和情感维度子量表也发现了类似的结果。根据 SF-36 身体成分、精神成分和一般健康分量表评估，过渡组和常规护理组之间的一般生活质量差异没有显着差异。出院后 12 周时，31% 的常规护理患者再次入院，而过渡护理组的这一比例为 23% (P = 0.26)，常规护理组有 46% 的患者前往急诊科就诊，而过渡护理组的这一比例为 29% (chi(2) = 4.86，(df) (1)，P = 0.03)。结论。与过渡护理相关的健康相关生活质量 (HRQL) 显着改善，并且急诊室的使用减少。
BACKGROUND. The growing number of patients with congestive heart failure has increased both the pressure on hospital resources and the need for community management of the condition. Improving hospital-to-home transition for this population is a logical step in responding to current practice guidelines' recommendations for coordination and education. Positive outcomes have been reported from trials evaluating multiple interventions, enhanced hospital discharge, and follow-up through the addition of a case management role. The question remains if similar gains could be achieved working with usual hospital and community nurses.METHODS. A 12-week, prospective, randomized controlled trial was conducted of the effect of transitional care on health-related quality of life (disease-specific and generic measures), rates of readmission, and emergency room use. The nurse-led intervention focused on the transition from hospital-to-home and supportive care for self-management 2 weeks after hospital discharge.RESULTS. At 6 weeks after hospital discharge, the overall Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was better among the Transitional Care patients (27.2 +/- 19.1 SD) than among the Usual Care patients (37.5 +/- 20.3 SD; P = 0.002). Similar results were found at 12 weeks postdischarge for the overall MLHFQ and at 6- and 12-weeks postdischarge for the MLHFQ's Physical Dimension and Emotional Dimension subscales. Differences in generic quality life, as assessed by the SF-36 Physical component, Mental Component, and General Health subscales, were not significantly different between the Transition and Usual Care groups. At 12 weeks postdischarge, 31% of the Usual Care patients had been readmitted compared with 23% of the Transitional Care patients (P = 0.26), and 46% of the Usual Care group visited the emergency department compared with 29% in the Transitional Care group (chi(2) = 4.86, (df) (1), P = 0.03).CONCLUSIONS. There were significant improvements in health-related quality of life (HRQL) associated with Transitional Care and less use of emergency rooms.