在ED的老年人中,边际倾向和共享决策:前性队列研究
Adrian D Haimovich1, Anita Chary2, Laura Burke1
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
概括
六分之一的老年人在急诊室 (ED) 接受了边际处置决定. 这些患者可能会从共享决策和替代护理途径中受益,以优化结果.
科学领域:
- 老年急救医学的医学
- 医疗保健服务研究 医疗服务研究
- 临床决策 - 临床决策
背景情况:
- 紧急部门 (ED) 对老年人的处置决定是复杂的,往往不确定的.
- 很少研究紧急医生对这些决定的实时观点.
研究的目的:
- 根据紧急医生认为老年人需要入院的情况,评估患者的结果.
- 为了识别老年成人ED倾向被医生认为是边缘性的.
主要方法:
- 在波士顿地区的学术三级保健ED患者65岁以上的前性队列研究.
- 医生使用5点的利克尔特比例来评估入院需求 (2-4被认为是边际的).
- 主要结局:ED倾向;次要结局:住院时间 (LOS),7天的ED返回,30天的死亡率.
主要成果:
- 18.2%的老年人倾向被认为是边际的.
- 边际配置与更长的处理时间,但更短的LOS和更高的早期放电率有关.
- 与非边际排放相比,边际排放的七天回报率较少.
结论:
- 大约六分之一的老年人ED处置被认为是边际的.
- 这些边缘病例代表了共享决策和替代护理途径的机会.
- 医生讨论了边缘病例的入院益处,而不是边缘病例的风险.
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