Landi F, Onder G, Tua E, Carrara B, Zuccalá G, Gambassi G, Carbonin P, Bernabei R
Department of Gerontology and Geriatrics, Catholic University of Sacred Heart, Rome, Italy.
J Am Geriatr Soc. 2001 Oct;49(10):1288-93. doi: 10.1046/j.1532-5415.2001.49264.x.
To evaluate the impact of a new assessment system, the Minimum Data Set for Home Care (MDS-HC), on the functional status and hospitalization rates of frail, community-dwelling older people.
Single-blind randomized trial with 1-year follow-up.
Bergamo, Italy.
All 187 subjects who were eligible for home care services delivered by two Health Districts between September 1998 and April 1999.
Random allocation to an intervention group undergoing MDS-HC assessment or to a control group receiving conventional geriatric assessment with Barthel, Lawton and Brody, and Mini-Mental State Examination (MMSE) scales.
Hospitalization, health services use and costs, and variations in functional status.
Survival analysis indicated that the intervention group was admitted to the hospital later and less often than were controls (relative risk = 0.49, 95% confidence interval = 0.56-0.97). Health services were used to the same extent, but intervention subjects used more in-home help services. Total costs for the intervention group were 21% lower than for the control group. The adjusted mean scores of the activities of daily living index (51.7+/-36.1 vs 46.3+/-33.7; P = .05) and MMSE (19.9+/-8.9 vs 19.2+/-10.7; P = .03) were significantly improved in the intervention group as compared with the control group.
The MDS-HC assessment instrument may provide a cost-saving approach to reducing institutionalization and functional decline in older people living in the community.
评估一种新的评估系统——家庭护理最小数据集（MDS-HC）对体弱的社区老年人功能状态和住院率的影响。
为期1年随访的单盲随机试验。
意大利贝加莫。
1998年9月至1999年4月期间，两个健康区所有符合家庭护理服务条件的187名受试者。
随机分配至接受MDS-HC评估的干预组或接受采用巴氏指数、洛顿和布罗迪量表以及简易精神状态检查表（MMSE）进行的传统老年评估的对照组。
住院情况、卫生服务利用和费用以及功能状态变化。
生存分析表明，干预组比对照组住院时间更晚且住院频率更低（相对风险=0.49，95%置信区间=0.56-0.97）。两组卫生服务利用程度相同，但干预组受试者使用了更多的居家帮助服务。干预组的总费用比对照组低21%。与对照组相比，干预组日常生活活动指数的调整后平均得分（51.7±36.1对46.3±33.7；P=0.05）和MMSE（19.9±8.9对19.2±10.7；P=0.03）显著改善。
MDS-HC评估工具可能为减少社区老年人的机构化和功能衰退提供一种节省成本的方法。
