Naylor Mary D, Brooten Dorothy A, Campbell Roberta L, Maislin Greg, McCauley Kathleen M, Schwartz J Sanford
Gerontological Nursing Science Center, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Am Geriatr Soc. 2004 May;52(5):675-84. doi: 10.1111/j.1532-5415.2004.52202.x.
To examine the effectiveness of a transitional care intervention delivered by advanced practice nurses (APNs) to elders hospitalized with heart failure.
Randomized, controlled trial with follow-up through 52 weeks postindex hospital discharge.
Six Philadelphia academic and community hospitals.
Two hundred thirty-nine eligible patients were aged 65 and older and hospitalized with heart failure.
A 3-month APN-directed discharge planning and home follow-up protocol.
Time to first rehospitalization or death, number of rehospitalizations, quality of life, functional status, costs, and satisfaction with care.
Mean age of patients (control n=121; intervention n=118) enrolled was 76; 43% were male, and 36% were African American. Time to first readmission or death was longer in intervention patients (log rank chi(2)=5.0, P=.026; Cox regression incidence density ratio=1.65, 95% confidence interval=1.13-2.40). At 52 weeks, intervention group patients had fewer readmissions (104 vs 162, P=.047) and lower mean total costs ($7,636 vs $12,481, P=.002). For intervention patients, only short-term improvements were demonstrated in overall quality of life (12 weeks, P<.05), physical dimension of quality of life (2 weeks, P<.01; 12 weeks, P<.05) and patient satisfaction (assessed at 2 and 6 weeks, P<.001).
A comprehensive transitional care intervention for elders hospitalized with heart failure increased the length of time between hospital discharge and readmission or death, reduced total number of rehospitalizations, and decreased healthcare costs, thus demonstrating great promise for improving clinical and economic outcomes.
探讨高级执业护士（APN）实施的过渡性护理干预对因心力衰竭住院的老年人的有效性。
随机对照试验，出院后随访52周。
费城的六家学术和社区医院。
239名符合条件的患者年龄在65岁及以上，因心力衰竭住院。
一项为期3个月的由APN指导的出院计划和家庭随访方案。
首次再住院或死亡时间、再住院次数、生活质量、功能状态、费用以及对护理的满意度。
纳入患者（对照组n = 121；干预组n = 118）的平均年龄为76岁；43%为男性，36%为非裔美国人。干预组患者首次再入院或死亡的时间更长（对数秩检验χ² = 5.0，P = 0.026；Cox回归发病率密度比 = 1.65，95%置信区间 = 1.13 - 2.40）。在52周时，干预组患者的再住院次数更少（104次对162次，P = 0.047），平均总费用更低（7636美元对12481美元，P = 0.002）。对于干预组患者，仅在总体生活质量（12周，P < 0.05）、生活质量的身体维度（2周，P < 0.01；12周，P < 0.05）和患者满意度（在2周和6周评估，P < 0.０01）方面显示出短期改善。
针对因心力衰竭住院的老年人的综合过渡性护理干预延长了出院至再入院或死亡之间的时间，减少了再住院总数，并降低了医疗费用，因此在改善临床和经济结局方面显示出巨大潜力。
