Burton L C, German P S, Gruber-Baldini A L, Hebel J R, Zimmerman S, Magaziner J
Health Services Research and Development Center, School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
J Am Geriatr Soc. 2001 Feb;49(2):142-7. doi: 10.1046/j.1532-5415.2001.49034.x.
To understand the use of medical services by nursing home residents.
Descriptive, longitudinal study comparing medical service use of residents by dementia status and describing the use of medical services following detection of fever or infection.
Fifty-nine randomly selected nursing homes in Maryland from 1992 to 1995.
2,153 residents admitted to one of 59 randomly selected nursing homes.
A panel of psychiatrists and neurologists ascertained dementia based on review of medical records, interview data with significant others and nursing staff, and results of a cognitive exam. Medical service use was abstracted from medical records.
Understanding the use of medical services by nursing home residents as distinct from services provided by the nursing home is important, particularly as new medical care models are tested. This study compares the medical service use of residents by dementia status and describes the use of medical services following detection of fever or infection.
Residents with dementia compared with those without dementia had lower annual rates of physician visits (10.2 vs 12.7, P < .001) and hospitalizations (0.9 vs 1.2, P < .001), virtually the same rate of emergency department visits, and similar lengths of stay in the hospital. Subsequent to infection, a lower proportion of residents with dementia had either a physician visit, an emergency department visit, or a hospital admission compared with residents without dementia (27.2% vs 32.2%, P < .001). In 87% of infections, an antibiotic was used, implying meaningful contact with a physician. Residents with dementia compared with those without dementia had fewer physician visits subsequent to fevers (20.6% vs 29.9%, P < .001) and infections (21.8% vs 27.5%, P < .001).
The association of less medical service use by individuals with dementia compared with those without dementia may reflect differences in health status or implicit end-of-life decision-making and a proclivity toward less-aggressive treatment for these individuals.
了解疗养院居民对医疗服务的使用情况。
描述性纵向研究，比较不同痴呆状态居民的医疗服务使用情况，并描述发热或感染被发现后医疗服务的使用情况。
1992年至1995年从马里兰州随机选取的59家疗养院。
随机选取的59家疗养院中收治的2153名居民。
一组精神科医生和神经科医生通过查阅病历、与重要他人及护理人员的访谈数据以及认知检查结果来确定痴呆症。医疗服务使用情况从病历中提取。
了解疗养院居民对医疗服务的使用情况（有别于疗养院提供的服务）很重要，尤其是在测试新的医疗护理模式时。本研究比较了不同痴呆状态居民的医疗服务使用情况，并描述了发热或感染被发现后医疗服务的使用情况。
与无痴呆症的居民相比，患有痴呆症的居民每年看医生的次数较少（10.2次对12.7次，P <.001），住院率较低（0.9次对1.2次，P <.001），急诊就诊率几乎相同，住院时间相似。感染后，与无痴呆症的居民相比，患有痴呆症的居民看医生、急诊就诊或住院的比例较低（27.2%对32.2%，P <.001）。在87%的感染病例中使用了抗生素，这意味着与医生有实际接触。与无痴呆症的居民相比，患有痴呆症的居民发热后看医生的次数较少（20.6%对29.9%，P <.001），感染后看医生的次数也较少（21.8%对27.5%，P <.001）。
与无痴呆症的人相比，患有痴呆症的人较少使用医疗服务，这可能反映了健康状况的差异或隐性的临终决策，以及对这些人采取不太积极治疗的倾向。
