After Discharge management of Low Income Frail Elderly

低收入体弱老人出院后管理

• 批准号: 7291520
• 负责人: KYLE RICHARD ALLEN
• 金额: $ 26.05万
• 依托单位: SUMMA HEALTH
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2009-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7291520
• 关键词: After; Discharge; management; Low; Income

As the US population ages, the health care system must change its emphasis from episodic acute illness treatment to a chronic illness management model to improve the quality, appropriateness, and effectiveness of health care services. Evidence based guidelines and quality indicators have been developed to promote improvements in clinical practice for the vulnerable elderly, however primary care physicians (PCPs) rarely have the time, expertise, or incentive to provide the most effective evidence based care. Referring these patients to the multiple specialists required to deal with the complex biopsychosocial problems often results in ineffective fragmented care and poor outcomes. Delivery of comprehensive care management using an interdisciplinary team (IT) that collaborates with the PCP has been shown to be an effective organizational model in chronic illness care. With this model, a care manager is usually assigned to provide patient follow up across all care settings and providers to ensure integration of medical and social issues. Use of this model to deliver healthcare services seems especially appropriate with frail elderly as a method to increase access to the expertise of the relatively few trained Geriatricians with the numerous PCPs who lack formal training in Geriatrics, yet care for increasing numbers of vulnerable older adults. Observational data from numerous care management programs indicate that this is a cost effective way to deliver optimal chronic illness care, however randomized trial evidence is lacking. This randomized trial will test the effectiveness of improved clinical practice through comprehensive care management in elderly patients with chronic illness and functional impairment discharged from an acute care hospital. For the intervention group, patient care will be coordinated by a nurse care manager who will perform a comprehensive in home assessment and provide patient education and self management support. The care manager will work with an IT to develop and implement a plan of care. Evidence based care plans will be implemented in collaboration with the patient, the PCP, the local Area Agency on Aging (AAoA), and other community social agencies. The care manager will provide frequent patient follow up across all providers to ensure integration of medical and social issues. Control patients will be referred to the local AAoA with no IT follow up. Although control patients will receive, through the AAoA, referrals for care and psychosocial support, the absence of a care manager and IT will, we expect, result in functional decline, lower quality of life, and higher health care costs. The intervention (n=265) and control (n=265) groups will be compared at 1 year on a profile of health and well being using a multiple endpoint global hypothesis testing strategy. The global measure will be comprised of the following 5 domains: function, institutionalization, quality of life, quality of medical management, and quality of self management. Priority populations identified by AHRQ who are targeted in this study include the elderly, patients with chronic illnesses, low income (dual eligible), and patients with disabilities. This study also includes minorities, women, and patients who live in the inner city. Cost effectiveness will be studied in a secondary analysis using incremental net benefit analysis. Economic analyses of benefits will inform policy makers about funding care management in AHRQ priority populations.

随着美国人口老龄化，医疗保健系统必须改变其重点，不再强调突发的急性疾病 慢性病治疗管理模式，以提高质量、适当性和有效性 医疗保健服务。制定了以证据为基础的指南和质量指标，以促进 改善弱势老年人的临床实践，但初级保健医生(PCP)很少 有时间、专业知识或动机提供最有效的循证护理。参考这些内容 患者需要多个专家来处理复杂的生物、心理和社会问题，结果往往是 低效、分散的护理和糟糕的结果。 使用跨学科团队(IT)提供全面护理管理，该团队与 PCP已被证明是慢性病护理的一种有效的组织模式。使用此型号， 护理经理通常被指派在所有护理环境和提供者中提供患者随访，以 确保医疗和社会问题的融合。使用这种模式来提供医疗服务似乎 特别适合于体弱多病的老年人，作为增加获得相对较少的专业知识的机会的一种方法 受过培训的老年医生有许多初级保健医生，他们缺乏老年医学方面的正式培训，但关心日益增长的 弱势老年人的数量。来自多个护理管理项目的观察数据表明 这是一种提供最佳慢性病护理的成本效益高的方式，无论随机试验证据如何 缺乏。 这项随机试验将测试通过综合护理改进的临床实践的有效性。 老年慢性病合并功能障碍患者急诊出院的处理 医院。对于干预组，病人护理将由一名护士护理经理协调，他将 进行全面的家庭评估，并提供患者教育和自我管理支持。 护理经理将与IT部门一起制定和实施护理计划。循证护理计划 将与患者、初级保健医生、当地老龄机构(AAoA)合作实施，以及 其他社区社会机构。护理经理将为所有患者提供频繁的随访 医疗服务提供者确保将医疗和社会问题结合起来。对照病人将转诊至当地 没有IT跟进的AAoA。尽管对照患者将通过AAoA获得转诊治疗和 我们预计，心理社会支持、缺乏护理经理和IT将导致功能衰退， 较低的生活质量和较高的医疗费用。 干预组(n=265)和对照组(n=265)在1年后的健康状况和 很好地使用了多端点全局假设检验策略。全球措施将是 包括以下5个领域：功能、制度化、生活质量、医疗质量 管理，自我管理的质量。AHRQ确定的优先人群，目标是 这项研究包括老年人、慢性病患者、低收入(双重资格)患者和 残疾人士。这项研究还包括居住在市中心的少数民族、妇女和患者。成本 有效性将在二次分析中使用增量净效益分析进行研究。经济上的 对福利的分析将使政策制定者了解AHRQ优先人群的资金护理管理。