OUTCOMES OF A NURSE-MANAGED GERIATRIC DAY HOSPITAL

美国迅速增长的高龄老人队伍正面临着 不适应他们的新兴医疗保健的医疗保健系统 需求，需求日益下降，在国家之间的严重差距 和长期护理系统。借鉴欧洲模式解决 这一差距，1993年10月，宾夕法尼亚大学商学院 护士开办护士管理的老年日间医院--协作式 老年人评估和康复(CARE)计划。目的 这项研究是为了对护理进行科学的评估，并 跨学科的老年日间医院，提供全面的 评估及短期密集康复服务以加强 体弱和慢性病患者在日常生活活动中的作用 有需要住院或入住疗养院的长者 没有这样的细心。这项评估将评估 日间医院改善了功能状况并减少了医疗保健 服务用途，尤其是为体弱者提供的医院和疗养院 老年人。本研究的具体目的是：1)系统地 描述接受护理服务的患者群体的情况 社会人口学特征、健康和功能状况以及既往 卫生服务的使用情况。对招生情况的全面描述性分析 将进行日间医院，并提供参与者的详细资料 谁完成了他们的护理计划将被建立。2)识别 并从Medicare中选择规模足够大的适当控制组 管理数据库，以便能够测试 关心。控制组将从新的联邦医疗保险中选出 管理数据库--联邦医疗保险当前受益人调查--使用 基于属性的倾向性评分方法和案例匹配协议 护理参与者的概况。3)评估护理对以下方面的影响 急诊室使用、住院治疗、疗养院使用和功能 状态。日间医院的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成果衡量标准进行评估。4)评估 使用大型数据库的优势、劣势和总体用途 管理数据库和创新的控制组设计方法 在对患者结局和护理效果的准实验研究中。 对研究中采用的总体方法进行定性审查将 以及派生和使用对照组的可行性 从这样的数据库中，护理结果研究将被调查。

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.