改善在养老院使用临终关怀服务:一个随机对照试验
David Casarett1, Jason Karlawish, Knashawn Morales
1Center for Health Equity Research and Promotion at the Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA. casarett@mail.med.upenn.edu
JAMA
|July 15, 2005
概括
一项沟通干预措施显著增加了临终关怀的入院人数,并改善了养老院居民的终身护理质量. 这种方法还减少了急性护理的利用率,提高了患者和家庭的整体满意度.
科学领域:
- 老年学是指老年学的学科.
- 抚慰性护理是一种缓解性护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 临终关怀可以提高养老院居民的终身护理质量.
- 在这群人群中,临终关怀的利用率仍然很低,通常是由于医生对患者偏好的不知情.
研究的目的:
- 评估是否确定适合临终关怀的住户可以增加利用率并提高终身护理质量.
- 评估沟通干预对宿舍招生和护理质量的影响.
主要方法:
- 一项随机对照试验,涉及205名养老院居民及其代理决策者在美国3个设施.
- 使用结构化访谈来识别适合住院的住户的干预措施,然后通知医生进行住院信息访问.
主要成果:
- 在干预组中,30天内入住临终关怀的比例显著高于干预组 (20%与1%相比;P<.001).
- 干预患者的急性护理入院次数较少 (0.28与0.49;P=.04) 和急性护理停留时间较短 (1.2与3.0天;P=.03).
- 干预居民的家庭报告了更高的护理质量评级 (4.1比2.5;P=.04).
结论:
- 简单的沟通干预有效地增加了临终关怀转诊率,并提高了终身护理的评级.
- 这种干预也可能导致急性护理资源利用率降低.
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