Caplan Gideon A, Meller Anne, Squires Barbara, Chan Stella, Willett Wendy
Prince of Wales Hospital, Post Acute Care Services, Sydney, NSW, Australia.
Age Ageing. 2006 Nov;35(6):581-5. doi: 10.1093/ageing/afl063. Epub 2006 Jun 28.
the number of nursing home residents (NHRs) in hospital is increasing although hospital admission may be deleterious to their health.
to evaluate a system of educating residents, their families, staff and general practitioners about outcomes of dementia, advance care planning (ACP) and hospital in the home.
we employed one clinical nurse consultant, who utilised the 'Let Me Decide' Advance Care Directive. The intervention area consisted of two hospitals and the 21 nursing homes (NHs) around them compared with another, geographically separate, hospital and the 13 homes around it. We conducted a controlled evaluation monitoring emergency admissions to hospital.
emergency calls to the ambulance service from intervention NHs decreased (intervention versus control; -1 versus +21%; P = 0.0019). The risk of a resident being in an intervention hospital bed for a day compared with in a control hospital bed, per NH bed, fell by a quarter from being initially similar [Relative Risk (RR) = 1.01; 95% confidence interval (CI) 0.98-1.04; P = 0.442] to being lower (RR = 0.74; 95% CI 0.72-0.77; P<0.0001). There was no significant change in mortality in the intervention homes, but in the control homes mortality rose in the third year to be 11.2 per 100 beds higher than in the intervention area (P<0.05).
ACP and hospital in the home can result in decreased hospital admission and mortality of NHRs.
尽管住院可能对养老院居民的健康有害，但住院的养老院居民数量仍在增加。
评估一个针对居民、其家属、工作人员和全科医生开展关于痴呆症预后、预先护理计划（ACP）和居家医院护理教育的系统。
我们聘请了一名临床护士顾问，其采用了“让我来决定”预先护理指示。干预区域包括两家医院及其周边的21家养老院，与另一地理上独立的医院及其周边的13家养老院进行对比。我们进行了一项对照评估，监测紧急住院情况。
来自干预养老院的救护车服务紧急呼叫减少（干预组与对照组；-1% 对 +21%；P = 0.0019）。与对照医院病床相比，干预医院每张养老院病床的居民住院一天的风险从最初相似水平下降了四分之一[相对风险（RR）= 1.01；95%置信区间（CI）0.98 - 1.04；P = 0.442]，降至更低水平（RR = 0.74；95% CI 0.72 - 0.77；P < 0.0001）。干预养老院的死亡率没有显著变化，但对照养老院的死亡率在第三年上升，比干预区域每100张病床高出11.2例（P < 0.05）。
预先护理计划和居家医院护理可降低养老院居民的住院率和死亡率。
