Kwok Timothy, Lee Jenny, Woo Jean, Lee Diana Tf, Griffith Sian
Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
J Clin Nurs. 2008 Jan;17(1):109-17. doi: 10.1111/j.1365-2702.2007.01978.x.
To evaluate the effectiveness and cost-effectiveness of a community nurse-supported hospital discharge programme in preventing hospital re-admissions, improving functional status and handicap of older patients with chronic heart failure.
Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re-admission at six months. Secondary outcomes were number of unplanned re-admissions, six-minute walking distance, London Handicap Scale and public health care and personal care costs.
At sixth months, the re-admission rates were not significantly different (46 vs. 57% in control subjects, p = 0.233, Chi-square test). But the median number of re-admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0.057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0.5 in control subjects, p = 0.002, Mann Whitney test), but there was no difference in six-minute walking distance. There was no significant group difference in median total public health care and personal care costs.
Community nurse-supported post-discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re-admissions. The cost benefits to public health care were not significant.
Older chronic heart failure patients are likely to benefit from post-discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken.
评估由社区护士支持的出院计划在预防老年慢性心力衰竭患者再次入院、改善其功能状态及残疾状况方面的有效性和成本效益。
随机对照试验；105名年龄在60岁及以上、患有慢性心力衰竭且前一年有住院史的住院患者被随机分为干预组（n = 49）和对照组（n = 56），为期六个月。干预组患者在出院前、出院后七天内、每周一次共四周、然后每月接受社区护士家访。社区护士与医院指定专家密切联络，在正常工作时间为患者提供服务。对照组和干预组患者在同一专科医疗诊所接受随访。主要结局是六个月时计划外再次入院率。次要结局包括计划外再次入院次数、六分钟步行距离、伦敦残疾量表以及公共医疗保健和个人护理费用。
在六个月时，再次入院率无显著差异（对照组为46%，干预组为57%，p = 0.233，卡方检验）。但干预组再次入院的中位数人数有降低趋势（对照组为1，干预组为0，p = 0.057，曼-惠特尼检验）。干预组患者在独立性方面的残疾程度较轻（中位数变化：对照组为0.5，干预组为0，p = 0.002，曼-惠特尼检验），但六分钟步行距离无差异。公共医疗保健和个人护理总费用中位数在两组间无显著差异。
由社区护士支持的出院后计划在保持独立性方面有效，且可能在减少计划外再次入院次数方面有效。对公共医疗保健的成本效益不显著。
老年慢性心力衰竭患者可能从出院后社区护士干预计划中获益。需要进行更全面的卫生经济评估。
