Intermediate care—Hospital-at-Home in chronic obstructive pulmonary disease: British Thoracic Society guideline
Intermediate care—Hospital-at-Home in chronic obstructive pulmonary disease: British Thoracic Society guideline
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中级护理——慢性阻塞性肺疾病的家庭医院：英国胸科学会指南
DOI：
10.1136/thx.2006.064931
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发表时间：
2006
期刊：
影响因子：
10
通讯作者：
Dr R Stevenson
中科院分区：
文献类型：
--
作者：
Dr R Stevenson
2006年5月5日收到2006年8月23日接受. . . . . . . . . . . . . . . . . . . . . . .中介照护是一种介于医院与社区照护之间的治疗模式。它通常涉及医院医生，全科医生，护士，物理治疗师和其他医疗保健专业人员之间的合作。中级护理的一个特定亚型是家庭医院（HaH），其中由医疗保健专业人员在患者家中提供积极治疗，否则将需要医院护理，总是在有限的时间内。2003年，一项科克伦系统综述得出结论，HaH是一种安全有效的治疗方法，用于选定的慢性阻塞性肺疾病（COPD）急性加重患者，并建议四分之一的急诊入院患者适合在护理支持下进行家庭治疗，尽管有些人认为这低估了HaH的合格性（史蒂文森，2005）。2004年，国家临床优化研究所（NICE）COPD指南纳入了COPD急性加重时HaH的评估。对住院治疗（避免住院）和协助或提前出院计划（短期住院后进行家庭护理）进行了区分。我们认为，将早期或辅助出院的病例从HaH中排除是不合逻辑的，在本指南中，我们将HaH视为一种治疗方式，包括避免入院和早期支持出院。NICE指南确定了4项随机对照试验（RCT）和1项服务评价，适用于COPD急性加重患者避免入院，1项RCT与早期支持出院相关。证据陈述可概述如下：
Received 5 May 2006 Accepted 23 August 2006 . . . . . . . . . . . . . . . . . . . . . . . . I ntermediate care is a treatment model which bridges the interface between hospital and community care. It often involves cooperation between hospital doctors, general practitioners, nurses, physiotherapists and other healthcare professionals. A specific subtype of intermediate care is Hospital-at-Home (HaH), where active treatment is provided by healthcare professionals in the patient’s home for a condition that otherwise would require hospital care, always for a limited period. In 2003 a Cochrane systematic review concluded that HaH was a safe and effective treatment approach for selected patients with exacerbations of chronic obstructive pulmonary disease (COPD), and suggested that one in four patients presenting to hospital as an emergency would be suitable for home treatment with nursing support, although some felt that this was an underestimate of eligibility for HaH (Stevenson, 2005). In 2004 the National Institute for Clinical Excellence (NICE) COPD guidelines included appraisal of HaH in exacerbations of COPD. A distinction was made between HaH (where hospital admission was avoided) and assisted or early discharge schemes (where a short initial admission was followed by home care). We suggest that it is illogical to exclude cases of early or assisted discharge from HaH and, in this guideline, we will consider HaH as a treatment modality which encompasses both admission avoidance and early supported discharge. The NICE guideline identified four randomised controlled trials (RCTs) and one service evaluation which were applicable to admission avoidance for patients with exacerbations of COPD, and one RCT related to early supported discharge. The evidence statements can be summarised as follows: