Kauh Bong, Polak Tracy, Hazelett Susan, Hua Keding, Allen Kyle
Division of Geriatric Medicine, Summa Health System, Akron, OH 44304, USA.
J Am Med Dir Assoc. 2005 Sep-Oct;6(5):321-6. doi: 10.1016/j.jamda.2005.04.008.
To compare discharge outcomes, postdischarge health care use, and death rates among patients treated in a postacute geriatric rehabilitation unit (GRU) housed within a skilled nursing facility (SNF) with those treated in a traditional SNF.
Retrospective observational pilot study.
Two similar SNFs were compared.
All patients were admitted from the acute hospital to either the GRU (n = 95) or to the usual care (UC) SNF (n = 55).
The GRU intervention consisted of comprehensive geriatric assessment and weekly interdisciplinary team rounds with a geriatrician and a geriatric nurse practitioner (GNP). The geriatrician visited the GRU twice a week and the GNP was present 4 to 5 times per week. On discharge, GRU patients were followed up with telephonic case management for 1 year.
Demographic data collected included age, gender, and race. Information collected from each facility's patient records included admitting diagnosis, length of stay, discharge disposition, and functional outcomes. Emergency department (ED) visits and hospital readmissions for 1 year after discharge from the nursing facility were obtained from our institutional database. The Rehabilitation Outcome Measure (ROM) was used by each facility to measure functional status on admission and at the time of discharge.
Baseline patient characteristics were comparable between the 2 facilities. At discharge from the nursing facility, GRU patients showed greater improvement in ADLs and mobility, had a significantly shorter length of stay, and were discharged to home more often. At 1 year, GRU patients had significantly fewer hospital readmissions. GRU patients also had fewer ED visits and days in the hospital at 1 year, however these results were not significant.
These pilot results suggest that GRU may be an effective means to improve patient outcomes and reduce undesirable health care use after an acute illness. Further studies using a randomized design are needed.
比较在专业护理机构（SNF）内的急性后老年康复单元（GRU）接受治疗的患者与在传统SNF接受治疗的患者的出院结局、出院后医疗保健利用情况及死亡率。
回顾性观察性试点研究。
比较两家类似的SNF。
所有患者均从急症医院转入GRU（n = 95）或常规护理（UC）SNF（n = 55）。
GRU干预包括全面的老年医学评估以及每周由老年病医生和老年护理执业医师（GNP）进行的多学科团队查房。老年病医生每周到GRU查房两次，GNP每周到场4至5次。出院时，对GRU患者进行为期1年的电话病例管理随访。
收集的人口统计学数据包括年龄、性别和种族。从每个机构的患者记录中收集的信息包括入院诊断、住院时间、出院处置和功能结局。从我们的机构数据库中获取护理机构出院后1年内的急诊科（ED）就诊和再次住院情况。每个机构使用康复结局测量（ROM）来评估入院时和出院时的功能状态。
两家机构的患者基线特征具有可比性。在护理机构出院时，GRU患者在日常生活活动能力（ADL）和活动能力方面有更大改善，住院时间显著缩短，且更多地出院回家。在1年时，GRU患者的再次住院次数显著减少。GRU患者在1年时的ED就诊次数和住院天数也较少，然而这些结果并不显著。
这些试点结果表明，GRU可能是改善患者结局并减少急性疾病后不良医疗保健利用的有效手段。需要使用随机设计进行进一步研究。
