McCusker J, Verdon J, Tousignant P, de Courval L P, Dendukuri N, Belzile E
Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal, Quebec, Canada.
J Am Geriatr Soc. 2001 Oct;49(10):1272-81. doi: 10.1046/j.1532-5415.2001.49254.x.
To determine the effectiveness of a two-stage (screening and nursing assessment) intervention for older patients in the emergency department (ED) who are at increased risk of functional decline and other adverse outcomes.
Controlled trial, randomized by day of ED visit, with follow-up at 1 and 4 months.
Four university-affiliated hospitals in Montreal.
Patients age 65 and older expected to be released from the ED to the community with a score of 2 or more on the Identification of Seniors At Risk (ISAR) screening tool and their primary family caregivers. One hundred seventy-eight were randomized to the intervention, 210 to usual care.
The intervention consisted of disclosure of results of the ISAR screen, a brief standardized nursing assessment in the ED, notification of the primary care physician and home care providers, and other referrals as needed. The control group received usual care, without disclosure of the screening result.
Patient outcomes assessed at 4 months after enrollment included functional decline (increased dependence on the Older American Resources and Services activities of daily living scale or death) and depressive symptoms (as assessed by the short Geriatric Depression Scale). Caregiver outcomes, also assessed at baseline and 4 months, included the physical and mental summary scales of the Medical Outcomes Study Short Form-36. Patient and caregiver satisfaction with care were assessed 1 month after enrollment.
The intervention increased the rate of referral to the primary care physician and to home care services. The intervention was associated with a significantly reduced rate of functional decline at 4 months, in both unadjusted (odds ratio (OR) = 0.60, 95% confidence interval (CI) = 0.36-0.99) and adjusted (OR = 0.53, 95% CI = 0.31-0.91) analyses. There was no intervention effect on patient depressive symptoms, caregiver outcomes, or satisfaction with care.
A two-stage ED intervention, consisting of screening with the ISAR tool followed by a brief, standardized nursing assessment and referral to primary and home care services, significantly reduced the rate of subsequent functional decline.
确定针对急诊科（ED）中功能衰退及其他不良后果风险增加的老年患者的两阶段（筛查和护理评估）干预措施的有效性。
对照试验，根据急诊就诊日期随机分组，在1个月和4个月时进行随访。
蒙特利尔的四家大学附属医院。
65岁及以上、预计将从急诊科出院返回社区、在老年人风险识别（ISAR）筛查工具上得分2分或更高的患者及其主要家庭护理人员。178人被随机分配至干预组，210人接受常规护理。
干预包括披露ISAR筛查结果、在急诊科进行简短的标准化护理评估、通知初级保健医生和家庭护理服务提供者以及根据需要进行其他转诊。对照组接受常规护理，不披露筛查结果。
入组后4个月评估的患者结局包括功能衰退（对美国老年人资源与服务日常生活活动量表的依赖性增加或死亡）和抑郁症状（通过简短老年抑郁量表评估）。护理人员结局在基线和4个月时也进行评估，包括医学结局研究简表36的身体和精神总结量表。在入组1个月后评估患者和护理人员对护理的满意度。
干预提高了转诊至初级保健医生和家庭护理服务的比例。在未调整（优势比（OR）=0.60，95%置信区间（CI）=0.36 - 0.99）和调整（OR = 0.53，95% CI = 0.31 - 0.91）分析中，干预均与4个月时功能衰退率显著降低相关。干预对患者抑郁症状、护理人员结局或护理满意度无影响。
由使用ISAR工具进行筛查、随后进行简短的标准化护理评估以及转诊至初级和家庭护理服务组成的两阶段急诊科干预措施，显著降低了后续功能衰退的发生率。
