Feussner J R, Wieland D, Kayser-Jones J, Kramer A, Saunders W, Fretwell M
Health Services Research and Development Field Program (Center in Primary Care), Durham Veterans Affairs Medical Center, NC 27705.
J Am Geriatr Soc. 1991 Sep;39(9 Pt 2):45S-47S. doi: 10.1111/j.1532-5415.1991.tb05934.x.
Methodological issues relating to multi-site studies of inpatient geriatric evaluation and management units were the focus of this working group's deliberations. The group favored a randomized clinical trial in which the inpatient geriatric evaluation and management unit was coupled with outpatient geriatric care. Inclusion of a broad spectrum of patients stratified according to risk for poor hospital outcomes was proposed in order to obtain information on the types of patients that would be most likely to benefit. The need for a detailed definition and description of care in the unit and of "usual care" was emphasized. Serious concerns were raised about including both VA medical centers and private hospitals in the same trial due to differences in the implementation of such a program. Furthermore, fears of contamination of the control group suggested that hospitals could be randomized either to provide usual care or have a GEM unit. However, this strategy would necessitate that hospitals that have already developed inpatient GEM units would be excluded from the trial and could be costly because of the number of hospitals that would be required.
多中心住院老年评估与管理单元研究的方法学问题是该工作组审议的重点。该小组倾向于进行一项随机临床试验，其中住院老年评估与管理单元与门诊老年护理相结合。建议纳入根据不良医院结局风险分层的广泛患者群体，以便获取最有可能受益的患者类型的信息。强调了对该单元护理以及“常规护理”进行详细定义和描述的必要性。由于实施此类项目存在差异，对于在同一试验中纳入退伍军人医疗中心和私立医院提出了严重关切。此外，对对照组受到污染的担忧表明，医院可以随机分为提供常规护理或设有老年评估与管理单元。然而，这一策略将不得不把已经设立住院老年评估与管理单元的医院排除在试验之外，而且由于所需医院数量众多，成本可能很高。
