OUTCOMES OF A NURSE-MANAGED GERIATRIC DAY HOSPITAL

美国迅速增长的老年人队伍正面临着一个挑战。 医疗保健系统不适应他们新兴的医疗保健 需要，需要，越来越多的下降之间的差距差距国家的尖锐 长期护理系统。 借鉴欧洲模式， 1993年10月，宾夕法尼亚大学的 护理开设了一个护士管理的老年日间医院-合作 老年人评估和康复方案。 的目的 本研究旨在对CARE进行科学评价， 跨学科老年日间医院，提供全面的 评估和短期密集康复服务，以加强 体弱及长期病患者的日常生活功能 有需要入院或入住护养院的长者 没有这样的照顾。 这项评价将评估联合国 日间医院，以改善功能状况和减少保健 服务使用，特别是医院和疗养院，为体弱者 老人 本研究的具体目的是：（1）系统地 描述CARE服务的患者人群， 社会人口统计学特征、健康和功能状态以及既往 使用卫生服务。 一个完整的描述性分析的招生， 白天医院将进行，并详细介绍了参与者 完成护理计划的人将被确定。 2)以识别 并从医疗保险中选择足够规模的适当对照组， 行政数据库，以便能够测试 在乎 对照组将从新的医疗保险中选出 管理数据库-医疗保险当前受益人调查-使用 倾向评分方法和病例匹配方案的基础上， 护理参与者的个人资料。 3)评估援外社对下列方面的影响： 急诊室使用、住院、疗养院使用和功能 status. 日间医院参与者将与对照组进行比较 在选定的时间间隔内对这些关键结果进行测量。 4)评估 使用大容量数据库的优点、缺点和总体效用 行政数据库和创新的控制组设计方法 在病人治疗效果和护理效果的准实验性研究中。 对研究中采用的总体方法进行定性审查， 以及衍生和使用控制组的可行性 从这样的数据库中的护理结果的研究将进行调查。

The rapidly growing ranks of the oldest old in the U.S. are facing a health care system that does not accommodate their emerging health care needs, needs that increasingly fall in the gap between the nation's acute and long-term care systems. Borrowing from a European model to address this gap, in October, 1993 the University of Pennsylvania School of Nursing opened a nurse-managed geriatric day hospital--the Collaborative Assessment and Rehabilitation for Elders (CARE) Program. The purpose of this study is to conduct a scientific evaluation of CARE, an interdisciplinary geriatric day hospital that provides comprehensive assessment and short-term intensive rehabilitation services to enhance function in activities of daily living for frail and chronically ill elders who are at risk for hospitalization or nursing home admission without such care. This evaluation will assess the contribution of the day hospital to improved functional status and reductions in health care service use, especially hospitals and nursing homes, for the frail elderly. The specific aims of this study are: 1) To systematically describe the patient population served by CARE in terms of their sociodemographic characteristics, health and functional status, and prior use of health services. A full descriptive analysis of the admissions to the day hospital will be conducted, and a detailed profile of participants who complete their programs of care will be established. 2) To identify and select an appropriate control group of sufficient size from Medicare administrative databases in order to be able to test the effectiveness of CARE. The control group will be selected from a new Medicare administrative database--the Medicare Current Beneficiary Survey--using a propensity scoring methodology and case-matching protocol based on the profile of CARE participants. 3) To assess the impact of CARE on emergency room use, hospitalizations, nursing home use, and functional status. Day hospital participants will be compared to the control group on these key outcome measures at selected time intervals. 4) To assess the strengths, weaknesses, and overall utility of using large administrative databases and innovative control group design methodology in quasi-experimental studies of patient outcomes and care effectiveness. A qualitative review of the overall methodology applied in the study will be undertaken, and the feasibility of deriving and using a control group from such databases in a nursing outcome study will be investigated.