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在退伍军人事务医院实施监督步行计划的影响:一个渐进式,集群随机试验

Susan N Hastings¹, Karen M Stechuchak², Ashley Choate²

¹ADAPT Center of Innovation, Durham VA Health Care System; Departments of Medicine and Population Health Sciences, Duke University School of Medicine; Center for the Study of Aging and Human Development, Duke University; and Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina (S.N.H.).

Annals of internal medicine

|June 5, 2023

概括

实施STRIDE (为住院退伍军人提供有助的早期流动性) 步行计划,减少了医院出院到熟练护理设施的数量. 该计划没有影响住院时间或住院患者的下降.

科学领域:

老年病的医生老年病的医生
医院医院医疗医疗医疗医疗
实施科学实施科学

背景情况:

在试验中,医院步行计划可以改善出院后的功能能力.
在常规实践中有效性的证据有限.

研究的目的:

评估STRIDE (住院退伍军人协助早期流动) 计划对出院到熟练护理机构 (SNF),停留时间 (LOS) 和住院患者下降的影响.
评估住院退伍军人的监督步行计划在现实世界中的有效性.

主要方法:

在8家退伍军人事务医院进行了阶梯,集群随机试验.
包括60岁以上的社区住院患者,住院时间≥2天.
一般化的线性混合模型分析了结果,考虑到聚类和共变量.

主要成果:

排放到SNF从前风前的13%降至后风后的8% (OR,0.6;95%CI,0.5-0.8).
没有观察到停留时间 (率比1.0) 或住院患者跌倒 (OR,0.8) 的显著差异.
项目覆盖范围各不相同,每家医院有0.6%-22.7%的符合条件的患者参与.

结论:

尽管计划范围有限且可变,但STRIDE的实施与向SNF排放的几率降低有关.
医院步行计划没有显著改变住院时间或住院患者跌倒率.
研究结果表明,即使面临实施挑战,医院后护理过渡也可能带来潜在的好处.

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