在急诊室启动了息治疗:一个集群随机临床试验
Corita R Grudzen1, Nina Siman2, Allison M Cuthel2
1Division of Supportive and Acute Care Services, Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA
|January 15, 2025
概括
在急诊室启动息治疗的多组件干预措施并没有减少住院人数,也没有改善严重疾病的老年人使用医疗保健和生存率. 需要进一步的研究来优化紧急情况下的息护理.
科学领域:
- 老年学
- 缓和护理
- 紧急医疗
背景情况:
- 紧急诊所为面临严重危及生命的老年人提供了良好的缓解护理机会.
- 早期的缓解护理干预可以显著影响患者的治疗结果和医疗利用率.
研究的目的:
- 评估旨在在ED内启动息治疗的多组件干预措施的有效性.
- 该研究评估了该干预措施对严重疾病的老年人住院率,随后的医疗保健利用率和生存率的影响.
主要方法:
- 在29个美国ED中进行了集群随机化临床试验,涉及66岁或以上的短期死亡风险较高的患者.
- 干预包括多学科教育,基于模拟的沟通研讨会,临床决策支持以及ED工作人员的审计和反.
- 分析了98,922次ED访问的数据,比较干预实施前后的结果.
主要成果:
- 干预没有显著改变住院率 (64. 4% 干预前 vs 61. 3% 干预后).
- 在二次结果中没有发现显著差异,包括重症监护室入院,急救室再访,住院治疗,家庭医疗利用,再入院或6个月死亡率.
- 具体比率没有显著的变化,调整后的赔率比率一般接近1.0.
结论:
- 测试的多组分干预措施没有显著影响严重的,限制生命的老年人住院,随后的医疗保健使用或短期死亡率.
- 通过这种特殊的干预策略在ED中启动息治疗并没有带来预期的患者结果改善.
- 需要进一步研究在紧急情况下提供息护理的替代或改进策略.
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