Smith Andrew A, Carusone Soo B Chan, Willison Kathleen, Babineau Tamara J, Smith Stephanie D, Abernathy Tom, Marrie Tom, Loeb Mark
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.
BMC Geriatr. 2005 Jul 13;5:9. doi: 10.1186/1471-2318-5-9.
Despite the recent growth in home health services, data on clinical outcomes and acute health care utilization among older adults receiving homecare services are sparse. Obtaining such data is particularly relevant in Ontario where an increasing number of frail seniors receiving homecare are awaiting placement in long-term care facilities. In order to determine the feasibility of a large-scale study, we conducted a pilot study to assess utilization of acute health care services among seniors receiving homecare to determine associated clinical outcomes.
This prospective cohort study followed forty-seven seniors admitted to homecare by two homecare agencies in Hamilton, Ontario over a 12-month period. Demographic information and medical history were collected at baseline, and patients were followed until either termination of homecare services, death, or end of study. The primary outcome was hospitalization. Secondary outcomes included emergency department visits that did not result in hospitalization and death. Rates of hospitalization and emergency department visits without admission were calculated, and univariate analyses were performed to test for potential risk factors. Survival curves for accumulative rates of hospitalization and emergency department visits were created.
312 seniors were eligible for the study, of which 123 (39%) agreed to participate initially. After communicating with the research nurse, of the 123 who agreed to participate initially, 47 (38%) were enrolled in the study. Eleven seniors were hospitalized during 3,660 days of follow-up for a rate of 3.0 incident hospitalizations per 1,000 homecare-days. Eleven seniors had emergency department visits that did not result in hospitalization, for a rate of 3.3 incident emergency department visits per 1,000 homecare-days. There were no factors significantly associated with hospitalization or emergency department visits when adjustment was made for multiple comparisons.
The incidence of hospitalization and visits to the emergency department among seniors receiving homecare services is high. Getting satisfactory levels of enrollment will be a major challenge for larger prospective studies.
尽管近期家庭健康服务有所增长，但关于接受家庭护理服务的老年人临床结局和急性医疗保健利用情况的数据却很稀少。在安大略省，获取此类数据尤为重要，因为越来越多接受家庭护理的体弱老年人正在等待入住长期护理机构。为了确定大规模研究的可行性，我们开展了一项试点研究，以评估接受家庭护理的老年人对急性医疗保健服务的利用情况，并确定相关的临床结局。
这项前瞻性队列研究对安大略省汉密尔顿市两家家庭护理机构收治的47名老年人进行了为期12个月的跟踪。在基线时收集人口统计学信息和病史，对患者进行跟踪，直至家庭护理服务终止、死亡或研究结束。主要结局是住院治疗。次要结局包括未导致住院治疗的急诊科就诊和死亡。计算住院率和未住院的急诊科就诊率，并进行单因素分析以检验潜在风险因素。绘制了住院和急诊科就诊累积率的生存曲线。
312名老年人符合研究条件，其中123名（39%）最初同意参与。在与研究护士沟通后，最初同意参与的123名中，47名（38%）被纳入研究。在3660天的随访期间，11名老年人住院，住院率为每1000个家庭护理日3.0次住院事件。11名老年人有未导致住院治疗的急诊科就诊，就诊率为每1000个家庭护理日3.3次急诊科就诊事件。在对多重比较进行调整后，没有因素与住院或急诊科就诊显著相关。
接受家庭护理服务的老年人住院和急诊科就诊的发生率很高。对于更大规模的前瞻性研究来说，获得令人满意的入组水平将是一项重大挑战。
