Garåsen Helge, Windspoll Rolf, Johnsen Roar
Department of Public Health and General Practice, Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
BMC Public Health. 2007 May 2;7:68. doi: 10.1186/1471-2458-7-68.
Demographic changes together with an increasing demand among older people for hospital beds and other health services make allocation of resources to the most efficient care level a vital issue. The aim of this trial was to study the efficacy of intermediate care at a community hospital compared to standard prolonged care at a general hospital.
In a randomised controlled trial 142 patients aged 60 or more admitted to a general hospital due to acute illness or exacerbation of a chronic disease 72 (intervention group) were randomised to intermediate care at a community hospital and 70 (general hospital group) to further general hospital care.
In the intervention group 14 patients (19.4%) were readmitted for the same disease compared to 25 patients (35.7%) in the general hospital group (p = 0.03). After 26 weeks 18 (25.0%) patients in the intervention group were independent of community care compared to seven (10.0%) in the general hospital group (p = 0.02). There were an insignificant reduction in the number of deaths and an insignificant increase in the number of days with inward care in the intervention group. The number of patients admitted to long-term nursing homes from the intervention group was insignificantly higher than from the general hospital group.
Intermediate care at a community hospital significantly decreased the number of readmissions for the same disease to general hospital, and a significantly higher number of patients were independent of community care after 26 weeks of follow-up, without any increase in mortality and number of days in institutions.
人口结构变化以及老年人对医院床位和其他医疗服务需求的增加，使得将资源分配到最有效的护理级别成为一个至关重要的问题。本试验的目的是研究社区医院的中级护理与综合医院标准长期护理相比的疗效。
在一项随机对照试验中，142名60岁及以上因急性疾病或慢性病加重而入住综合医院的患者，72名（干预组）被随机分配到社区医院接受中级护理，70名（综合医院组）接受综合医院的进一步护理。
干预组有14名患者（19.4%）因同一疾病再次入院，而综合医院组有25名患者（35.7%）（p = 0.03）。26周后，干预组有18名（25.0%）患者不再需要社区护理，而综合医院组有7名（10.0%）（p = 0.02）。干预组的死亡人数略有减少，住院天数略有增加，但差异均无统计学意义。干预组入住长期疗养院的患者人数略高于综合医院组，但差异无统计学意义。
社区医院的中级护理显著减少了因同一疾病再次入住综合医院的人数，并且在随访26周后，有显著更多的患者不再需要社区护理，同时死亡率和住院天数均未增加。
