Campbell Susan E, Seymour D Gwyn, Primrose Willie R
The University of Aberdeen, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK.
Age Ageing. 2004 Mar;33(2):110-5. doi: 10.1093/ageing/afh036.
The ACMEplus project aims to devise a standardised system for measuring case-mix and outcome in older patients admitted to hospitals in different parts of Europe for primarily 'medical' (i.e. not surgical or psychiatric) reasons. As a first step in this project, a systematic review was carried out to identify factors which had a significant influence on outcome in such patients.
The systematic search used Medline 1966-2000, Cinahl 1982-2000, Web of Science 1981-2000, reference lists of relevant papers and a hand search of Age and Ageing 1974-2000. A six-category grading system was devised to classify the 313 identified papers with regard to their relevance to the ACMEplus project, study design and power. The analysis of the 14 'category 1' papers is presented.
The main areas of assessment of case-mix were function, cognition, depression, illness severity, nutrition, social elements, aspects of diagnosis and demographic details. Statistically significant predictors, for the four outcome measures, listed below were: For length of stay: functional status score, illness severity, cognitive score, poor nutrition, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender. For mortality: functional status score, illness severity, cognitive score, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender. For discharge destination: functional status score, cognitive score, diagnosis or presenting illness and age. For readmission rate: functional status score, illness severity, co-morbidity, polypharmacy, diagnosis or presenting illness and age.
Factors affecting outcome in older medical patients are complex. When looking at outcomes of hospital admission in older people it is important not just to look at routinely available statistics such as age, gender and diagnosis but also to take into account multifaceted aspects such as functional status and cognitive function.
ACMEplus项目旨在设计一个标准化系统，用于衡量欧洲不同地区因主要“医疗”（即非手术或精神科）原因入院的老年患者的病例组合和治疗结果。作为该项目的第一步，进行了一项系统综述，以确定对此类患者治疗结果有重大影响的因素。
系统检索使用了1966 - 2000年的Medline、1982 - 2000年的Cinahl、1981 - 2000年的Web of Science、相关论文的参考文献列表，并手动检索了1974 - 2000年的《衰老与老年》。设计了一个六类分级系统，根据313篇已识别论文与ACMEplus项目的相关性、研究设计和力度对其进行分类。本文呈现了对14篇“1类”论文的分析。
病例组合评估的主要领域包括功能、认知、抑郁、疾病严重程度、营养、社会因素、诊断方面和人口统计学细节。以下是针对四种治疗结果指标的具有统计学意义的预测因素：住院时间：功能状态评分、疾病严重程度、认知评分、营养不良、合并症评分、诊断或现患疾病、多种药物治疗、年龄和性别。死亡率：功能状态评分、疾病严重程度、认知评分、合并症评分、诊断或现患疾病、多种药物治疗、年龄和性别。出院去向：功能状态评分、认知评分、诊断或现患疾病和年龄。再入院率：功能状态评分、疾病严重程度、合并症、多种药物治疗、诊断或现患疾病和年龄。
影响老年内科患者治疗结果的因素很复杂。在看待老年人入院治疗结果时，重要的是不仅要查看常规可得的统计数据，如年龄、性别和诊断，还要考虑功能状态和认知功能等多方面因素。
