健康促进护士干预对患有心脏病的老年人残疾及医疗费用的影响。

Impact of a health promotion nurse intervention on disability and health care costs among elderly adults with heart conditions.

作者信息

Meng Hongdao, Wamsley Brenda R, Eggert Gerald M, Van Nostrand Joan F

机构信息

Department of Preventive Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794-8338, USA.

出版信息

J Rural Health. 2007 Autumn;23(4):322-31. doi: 10.1111/j.1748-0361.2007.00110.x.

DOI:10.1111/j.1748-0361.2007.00110.x

PMID:17868239

Abstract

CONTEXT

Patients with heart conditions in rural areas may have different responses to health promotion-disease Self-management interventions compared to their urban counterparts.

PURPOSE

To estimate the impact of a multi-component health promotion nurse intervention on physical function and total health care expenditures among elderly adults with heart conditions and to examine the impact of rural residence on the intervention effect.

METHODS

We analyzed data on 281 community-living Medicare beneficiaries with heart conditions from the Medicare Primary and Consumer-Directed Care Demonstration (a randomized controlled trial). We estimated ordinary least squares (OLS) models to determine the effect of the intervention on the change in functional status and log-linear models to determine the impact of the intervention on total health care expenditures over a 2-year period.

RESULTS

The OLS models showed that the nurse intervention resulted in fewer impairments in Activities of Daily Living (ADL) (-0.307 on 0-6 scale, P = .055) at the end of 2 years. The effect of the intervention on ADL appeared to be stronger for rural than for urban participants (-0.490 vs -0.162, respectively). However, the difference was not statistically significant (P = .150). The effect of the intervention on Instrumental Activities of Daily Living (IADL) was not significant (P = .321). Average total health care expenditures were 6.5% ($1,981, 95% CI: -$8,048, $4,087) lower in the nurse group.

CONCLUSIONS

The nurse intervention led to better physical functioning and has potential to reduce total health care expenditures among high-risk Medicare beneficiaries with heart conditions.

摘要

背景

与城市地区患有心脏病的患者相比，农村地区的患者对健康促进-疾病自我管理干预措施可能有不同的反应。

目的

评估多成分健康促进护士干预措施对患有心脏病的老年人身体功能和总医疗保健支出的影响，并检验农村居住环境对干预效果的影响。

方法

我们分析了医疗保险初级和消费者导向护理示范项目（一项随机对照试验）中281名患有心脏病的社区医疗保险受益人的数据。我们估计了普通最小二乘法（OLS）模型，以确定干预措施对功能状态变化的影响，并估计了对数线性模型，以确定干预措施对两年期间总医疗保健支出的影响。

结果

OLS模型显示，护士干预在两年结束时导致日常生活活动（ADL）受损减少（在0-6量表上为-0.307，P = 0.055）。干预措施对农村参与者的ADL影响似乎比对城市参与者更强（分别为-0.490和-0.162）。然而，差异无统计学意义（P = 0.150）。干预措施对工具性日常生活活动（IADL）的影响不显著（P = 0.321）。护士组的平均总医疗保健支出降低了6.5%（1981美元，95%可信区间：-8048美元，4087美元）。