Outcomes of a community-based dissemination of the health enhancement program
Outcomes of a community-based dissemination of the health enhancement program
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DOI：
10.1046/j.1532-5415.2002.50407.x
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发表时间：
2002-09-01
影响因子：
6.3
通讯作者：
LoGerfo, JP
中科院分区：
文献类型：
--
作者：
Phelan, EA;Williams, B;LoGerfo, JP
目的：我们之前在一项疗效试验中发现，在患有慢性病的社区老年人中，健康促进计划防止了功能衰退并减少了住院人数。我们试图评估该计划在传播阶段的有效性。设计：使用组内、前测-后测设计进行结果评估。设置：分布在华盛顿州西部的14个老年中心。伙伴：304名65岁及以上的社区居民男性和女性。干预：一项残疾预防、慢性病自我管理计划。测量：参与者特征、残疾的风险因素、健康和功能状况的变化、注册一年以上的医疗保健使用情况；参与者满意度。结果：参与者为71%的女性，平均年龄76岁，平均报告3种慢性健康状况。被发现抑郁的参与者的百分比下降(登记时为28%，1年随访时为17%，P=.005)。不经常运动的参与者的百分比下降(56%比38%，P=.001)。身体活动水平和运动准备情况有所改善(基于医生的运动评估和咨询平均得分为4.3分对5.1分，P=.001)。在随访中，83%的人认为自己的健康状况与一年前持平或好于一年前，而在注册时这一比例为73%。以卧床天数和限制活动天数衡量，功能状态受损的比例保持不变。住院比例保持稳定(登记和随访时为23%，P=1.0)。结论：在现实世界条件下，健康增强计划适用于有功能衰退风险的老年人。那些登记了一年的人经历了残疾风险因素的减少，健康状况的改善，功能状况没有下降，自我报告的医疗保健使用没有增加。
OBJECTIVES: We previously found in an efficacy trial that a health promotion program prevented functional decline and reduced hospitalizations in community-dwelling older people with chronic conditions. We sought to evaluate the effectiveness of the program in its dissemination phase.DESIGN: Outcome evaluation using a within-group, pretest-posttest design.SETTING: Fourteen senior centers located throughout western Washington.PARTICIPANTS: Three hundred four community-dwelling men and women aged 65 and older.INTERVENTION: A disability-prevention, chronic disease-self-management program.MEASUREMENTS: Participant characteristics, risk factors for disability, change in health and functional status, and healthcare use over 1 year of enrollment; participant satisfaction.RESULTS: Participants were 71% female, had a mean age of 76, and reported three chronic health conditions on average. The percentage of participants found to be depressed decreased (28% at time of enrollment vs 17% at 1-year follow-up, P =.005). The percentage of physically inactive participants decreased (56% vs 38%, P =.001). Physical activity level and exercise readiness improved (Physician-based Assessment and Counseling for Exercise mean score 4.3 vs 5.1, P =.001). At follow-up, 83% rated their health the same as or better than a year ago, compared with 73% at time of enrollment. The proportion with impaired functional status, as measured by bed days and restricted activity days, stayed the same. The proportion hospitalized remained stable (23% at enrollment and follow-up, P = 1.0).CONCLUSIONS: Under real world conditions, the Health Enhancement Program reaches older people at risk of functional decline. Those enrolled for 1 year experience a reduction in disability risk factors, improvement in health status, no decrements in functional status, and no increase in self-reported healthcare use.