Alessi Cathy A, Ouslander Joseph G, Maldague Sandra, Al-Samarrai Nahla R, Saliba Debra, Osterweil Dan, Beck John C, Schnelle John F
University of California at Los Angeles Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California 91343, USA.
J Am Med Dir Assoc. 2003 Mar-Apr;4(2 Suppl):S4-S18. doi: 10.1097/01.JAM.0000021173.43550.A9.
To determine the incidence of acute medical conditions in incontinent nursing home residents, and associated costs of diagnostic testing and treatment
Prospective, cohort study.
Three community nursing homes.
161 long-stay residents with urinary incontinence in (mean age 86 years, 77% female, 92% white).
Acute medical conditions were identified prospectively through medical record review based on standardized criteria. All diagnostic testing and treatment provided for these conditions were recorded, and related costs in the nursing home were assigned based on 1997-1998 Medicare and Medicaid reimbursement.
The highest incidences of illness were for dermatological conditions (107 episodes per 1000 patient-weeks, involving 70% of subjects), respiratory illnesses (29 per 1000 patient-weeks, 47% of subjects) and gas-trointestinal illnesses (24 per 1000 patient-weeks, 36% of subjects). Among episodes with an incidence of at least 5 per 1000 patient-weeks, the illness events with the highest median diagnostic testing and treatment costs per episode were pneumonia, acute bronchitis, and depression. Only 42 out of the total 1071 episodes identified resulted in a hospitalization. Significant predictors of higher illness incidence included greater baseline comorbidity and higher number of routine medications (model adjusted R-square = 0.319, P = 0.021).
Acute illness is very common among incontinent nursing home residents, and is generally diagnosed and treated at the nursing home site, with variation among conditions in associated costs. Important policy implications include resource allocation (including appropriate staffing patterns), educational and quality improvement activities, and future research and guideline development for the optimal management of medical conditions in the nursing home setting.
确定失禁养老院居民急性疾病的发病率以及诊断检测和治疗的相关费用
前瞻性队列研究
三家社区养老院
161名长期存在尿失禁的居民（平均年龄86岁，77%为女性，92%为白人）
根据标准化标准，通过病历回顾前瞻性地确定急性疾病。记录针对这些疾病所进行的所有诊断检测和治疗，并根据1997 - 1998年医疗保险和医疗补助的报销情况确定养老院的相关费用。
发病率最高的疾病是皮肤病（每1000患者周107例，涉及70%的受试者）、呼吸系统疾病（每1000患者周29例，47%的受试者）和胃肠道疾病（每1000患者周24例，36%的受试者）。在每1000患者周发病率至少为5例的发病情况中，每例发病的诊断检测和治疗费用中位数最高的疾病事件是肺炎、急性支气管炎和抑郁症。在总共确定的1071例发病情况中，只有42例导致住院。疾病发病率较高的显著预测因素包括更高的基线合并症和更多的常规用药（模型调整R方 = 0.319，P = 0.021）。
急性疾病在失禁养老院居民中非常常见，通常在养老院现场进行诊断和治疗，相关费用因疾病而异。重要的政策影响包括资源分配（包括适当的人员配置模式）、教育和质量改进活动，以及未来针对养老院环境中医疗状况最佳管理的研究和指南制定。
