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Measuring the quality of care provided to community dwelling vulnerable elders dually enrolled in Medicare and Medicaid.衡量为同时参加医疗保险和医疗补助计划的社区弱势老年人提供的护理质量。
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2
Relationship between number of medical conditions and quality of care.医疗状况数量与医疗质量之间的关系。
N Engl J Med. 2007 Jun 14;356(24):2496-504. doi: 10.1056/NEJMsa066253.
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Multimorbidity is associated with better quality of care among vulnerable elders.多种疾病并存与弱势老年人更好的医疗质量相关。
Med Care. 2007 Jun;45(6):480-8. doi: 10.1097/MLR.0b013e318030fff9.
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Quality of osteoarthritis care for community-dwelling older adults.社区居住老年人骨关节炎护理质量
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Quality of care is associated with survival in vulnerable older patients.医疗质量与脆弱老年患者的生存状况相关。
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Detection and management of falls and instability in vulnerable elders by community physicians.社区医生对脆弱老年人跌倒及身体不稳定状况的检测与管理。
J Am Geriatr Soc. 2004 Sep;52(9):1527-31. doi: 10.1111/j.1532-5415.2004.52417.x.
7
The quality of pharmacologic care for vulnerable older patients.弱势老年患者的药物治疗护理质量。
Ann Intern Med. 2004 May 4;140(9):714-20. doi: 10.7326/0003-4819-140-9-200405040-00011.
8
The quality of care provided to vulnerable older community-based patients with urinary incontinence.为社区中患有尿失禁的弱势老年患者提供的护理质量。
J Am Med Dir Assoc. 2004 May-Jun;5(3):141-6. doi: 10.1097/01.JAM.0000123026.47700.1A.
9
The quality of medical care provided to vulnerable older patients with chronic pain.为患有慢性疼痛的弱势老年患者提供的医疗服务质量。
J Am Geriatr Soc. 2004 May;52(5):756-61. doi: 10.1111/j.1532-5415.2004.52214.x.
10
The quality of medical care provided to vulnerable community-dwelling older patients.为社区居住的弱势老年患者提供的医疗服务质量。
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通科医生和接受过专科培训的老年病医生提供“老年病”护理方式的比较。

A comparison of how generalists and fellowship-trained geriatricians provide "geriatric" care.

作者信息

Phelan Elizabeth A, Genshaft Scott, Williams Barbara, LoGerfo James P, Wagner Edward H

机构信息

Department of Medicine, Divisions of Gerontology and Geriatric Medicine, , University of Washington, Seattle, Washington 98104, USA.

出版信息

J Am Geriatr Soc. 2008 Oct;56(10):1807-11. doi: 10.1111/j.1532-5415.2008.01942.x.

DOI:10.1111/j.1532-5415.2008.01942.x
PMID:19054199
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3003439/
Abstract

OBJECTIVES

To determine whether outpatient care provided to older patients by fellowship-trained geriatricians is distinguishable from that provided by generalists.

DESIGN

Observational study.

SETTING

Three primary care clinics of an academic medical center.

PARTICIPANTS

Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics.

MEASUREMENTS

A medical chart review involving records of 69 patients receiving primary care from a fellowship-trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults--avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes--was abstracted.

RESULTS

Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 (P<.001). Geriatricians scored higher than generalists on prescribing and geriatric syndrome assessments. In a linear regression model adjusting for patient age and number of comorbidities and clustering according to provider, provider specialty was strongly associated with overall score (beta coefficient for specialty=6.75, P<.001; 95% confidence interval=4.57-8.94).

CONCLUSION

The practice style of fellowship-trained geriatricians caring for older adults appears to differ from that of generalists with regard to prescribing behavior and assessment for geriatric syndromes.

摘要

目的

确定由专科培训的老年病医生为老年患者提供的门诊护理是否与全科医生提供的护理有所不同。

设计

观察性研究。

地点

一所学术医疗中心的三家初级保健诊所。

参与者

从其中一家诊所接受初级保健的140名65岁及以上成年人中随机抽样。

测量

对69名接受专科培训的老年病医生提供初级保健的患者和71名接受全科医生（普通内科或家庭医学）提供初级保健的患者的病历进行回顾；提取与老年人护理相关的两种执业行为的信息——避免不适当开药和对老年综合征进行主动评估。

结果

老年病医生平均得分为17.6分（满分24分）；全科医生得分为14.2分（P<0.001）。在开药和老年综合征评估方面，老年病医生得分高于全科医生。在根据患者年龄、合并症数量进行调整并按提供者进行聚类的线性回归模型中，提供者专业与总分密切相关（专业的β系数=6.75，P<0.001；95%置信区间=4.57-8.94）。

结论

在开药行为和老年综合征评估方面，接受专科培训的老年病医生照顾老年人的执业风格似乎与全科医生不同。