心力衰竭患者的生活质量：两种医院到家庭过渡模式有效性的随机试验

Quality of life of individuals with heart failure: a randomized trial of the effectiveness of two models of hospital-to-home transition.

作者信息

Harrison Margaret B, Browne Gina B, Roberts Jacqueline, Tugwell Peter, Gafni Amiram, Graham Ian D

机构信息

School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.

出版信息

Med Care. 2002 Apr;40(4):271-82. doi: 10.1097/00005650-200204000-00003.

DOI:10.1097/00005650-200204000-00003

PMID:12021683

Abstract

BACKGROUND

The growing number of patients with congestive heart failure has increased both the pressure on hospital resources and the need for community management of the condition. Improving hospital-to-home transition for this population is a logical step in responding to current practice guidelines' recommendations for coordination and education. Positive outcomes have been reported from trials evaluating multiple interventions, enhanced hospital discharge, and follow-up through the addition of a case management role. The question remains if similar gains could be achieved working with usual hospital and community nurses.

METHODS

A 12-week, prospective, randomized controlled trial was conducted of the effect of transitional care on health-related quality of life (disease-specific and generic measures), rates of readmission, and emergency room use. The nurse-led intervention focused on the transition from hospital-to-home and supportive care for self-management 2 weeks after hospital discharge.

RESULTS

At 6 weeks after hospital discharge, the overall Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was better among the Transitional Care patients (27.2 +/- 19.1 SD) than among the Usual Care patients (37.5 +/- 20.3 SD; P = 0.002). Similar results were found at 12 weeks postdischarge for the overall MLHFQ and at 6- and 12-weeks postdischarge for the MLHFQ's Physical Dimension and Emotional Dimension subscales. Differences in generic quality life, as assessed by the SF-36 Physical component, Mental Component, and General Health subscales, were not significantly different between the Transition and Usual Care groups. At 12 weeks postdischarge, 31% of the Usual Care patients had been readmitted compared with 23% of the Transitional Care patients (P = 0.26), and 46% of the Usual Care group visited the emergency department compared with 29% in the Transitional Care group (chi2 = 4.86, df 1, P = 0.03).

CONCLUSIONS

There were significant improvements in health-related quality of life (HRQL) associated with Transitional Care and less use of emergency rooms.

摘要

背景

充血性心力衰竭患者数量的不断增加，既加大了医院资源的压力，也增加了对该疾病进行社区管理的需求。改善这部分人群从医院到家庭的过渡，是响应当前实践指南中关于协调与教育建议的合理举措。多项评估干预措施、强化出院指导以及通过增设病例管理角色进行随访的试验均报告了积极成果。问题在于，与普通医院和社区护士合作是否也能取得类似成效。

方法

开展了一项为期12周的前瞻性随机对照试验，以研究过渡性护理对健康相关生活质量（疾病特异性和一般性指标）、再入院率及急诊室就诊率的影响。由护士主导的干预措施聚焦于从医院到家庭的过渡以及出院后2周的自我管理支持性护理。

结果

出院6周后，过渡性护理组患者的明尼苏达心力衰竭生活问卷（MLHFQ）总体得分（27.2±19.1标准差）优于常规护理组患者（37.5±20.3标准差；P = 0.002）。出院12周时，MLHFQ总体得分以及出院6周和12周时MLHFQ的身体维度和情感维度子量表也出现了类似结果。通过SF - 36身体成分、心理成分和总体健康子量表评估的一般性生活质量差异，在过渡性护理组和常规护理组之间无显著差异。出院12周时，常规护理组31%的患者再次入院，而过渡性护理组为23%（P = 0.26）；常规护理组46%的患者前往急诊室就诊，过渡性护理组为29%（卡方值 = 4.86，自由度1，P = 0.03）。