养老院中的主动照顾是否能提高生存率? 一个质量改进项目
David Attwood1, Suzy V Hope2,3, Stuart G Spicer4
1Pathfields Medical Group, Plymouth, UK davidattwood@nhs.net.
BMJ open quality
|June 4, 2024
概括
积极的医疗保健模式显著改善了养老院居民的2年生存率. 这种改进的模型,使用全面的老年病学评估和先进的护理计划,与单独的常规护理相比,死亡率降低了39.6%.
科学领域:
- 老年医学 老年医学
- 医疗保健管理的管理
- 提高质量 提高质量
背景情况:
- 英国NHS的倡议促进了养老院居民的积极医疗保健.
- 初级保健网络 (PCN) 负责这一工作,但在脆弱性识别,多学科团队 (MDT) 能力和流程实施方面面临挑战.
- 现有的模型往往侧重于反应性护理,可能错过了早期干预的机会.
研究的目的:
- 评估主动医疗保健模型在改善养老院居民生存结果方面的有效性.
- 确定是否整合综合老年医疗评估和先进护理规划可以改善住院护理.
- 评估PCN主导的MDT中心对养老院医疗保健服务的影响.
主要方法:
- 一个质量改善项目,涉及40个养老院的429名居民.
- 使用非随机交叉队列设计,将常规/反应性护理与主动性护理进行比较 (信息技术辅助综合老年评估[i-CGA]和高级护理规划[ACP]).
- 使用时间依赖的考克斯回归分析来评估2年生存率.
主要成果:
- 接受主动治疗的干预组的2年生存率为48.1%,明显高于对照组的8.6% (p<0.001).
- 这意味着绝对风险降低了39.6%,死亡率相对风险降低了70.2%.
- 需要治疗的数量计算为2.5,表明高疗效,经调整混变量后的变化最小.
结论:
- 基于PCN的MDT-hub模型,包括主动护理,i-CGA和ACP,显著改善了老年护理院居民的2年生存率.
- 积极的医疗保健干预措施为这个脆弱的人群提供了比紧急/反应性护理更大的好处.
- 这种模式代表了一种潜在的策略,可以提高养老院居民的健康结果和长寿.
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