Faculty of Health and Social Development, University of British Columbia,Okanagan, Canada.
BMC Health Serv Res. 2011 Aug 23;11:202. doi: 10.1186/1472-6963-11-202.
Older people have higher rates of hospital admission than the general population and higher rates of readmission due to complications and falls. During hospitalisation, older people experience significant functional decline which impairs their future independence and quality of life. Acute hospital services comprise the largest section of health expenditure in Australia and prevention or delay of disease is known to produce more effective use of services. Current models of discharge planning and follow-up care, however, do not address the need to prevent deconditioning or functional decline. This paper describes the protocol of a randomised controlled trial which aims to evaluate innovative transitional care strategies to reduce unplanned readmissions and improve functional status, independence, and psycho-social well-being of community-based older people at risk of readmission.
METHODS/DESIGN: The study is a randomised controlled trial. Within 72 hours of hospital admission, a sample of older adults fitting the inclusion/exclusion criteria (aged 65 years and over, admitted with a medical diagnosis, able to walk independently for 3 meters, and at least one risk factor for readmission) are randomised into one of four groups: 1) the usual care control group, 2) the exercise and in-home/telephone follow-up intervention group, 3) the exercise only intervention group, or 4) the in-home/telephone follow-up only intervention group. The usual care control group receive usual discharge planning provided by the health service. In addition to usual care, the exercise and in-home/telephone follow-up intervention group receive an intervention consisting of a tailored exercise program, in-home visit and 24 week telephone follow-up by a gerontic nurse. The exercise only and in-home/telephone follow-up only intervention groups, in addition to usual care receive only the exercise or gerontic nurse components of the intervention respectively. Data collection is undertaken at baseline within 72 hours of hospital admission, 4 weeks following hospital discharge, 12 weeks following hospital discharge, and 24 weeks following hospital discharge. Outcome assessors are blinded to group allocation. Primary outcomes are emergency hospital readmissions and health service use, functional status, psychosocial well-being and cost effectiveness.
The acute hospital sector comprises the largest component of health care system expenditure in developed countries, and older adults are the most frequent consumers. There are few trials to demonstrate effective models of transitional care to prevent emergency readmissions, loss of functional ability and independence in this population following an acute hospital admission. This study aims to address that gap and provide information for future health service planning which meets client needs and lowers the use of acute care services.
Australian & New Zealand Clinical Trials Registry ACTRN12608000202369.
老年人的住院率高于一般人群，且因并发症和跌倒而再次住院的比例更高。在住院期间，老年人的功能显著下降，这会影响他们未来的独立性和生活质量。急性医院服务在澳大利亚的卫生支出中占比最大，预防或延缓疾病的发生被认为可以更有效地利用服务。然而，目前的出院计划和后续护理模式并没有解决防止身体机能下降或功能下降的问题。本文介绍了一项随机对照试验的方案，旨在评估创新的过渡性护理策略，以减少无计划的再次入院，并改善有再次入院风险的社区老年人的功能状态、独立性和心理社会幸福感。
方法/设计：该研究是一项随机对照试验。在入院后 72 小时内，符合纳入/排除标准的老年患者（年龄在 65 岁及以上，因医学诊断入院，能独立行走 3 米，且至少有一个再次入院的风险因素）被随机分为四组之一：1）常规护理对照组，2）运动和家庭/电话随访干预组，3）仅运动干预组，或 4）仅家庭/电话随访干预组。常规护理对照组接受卫生服务提供的常规出院计划。除常规护理外，运动和家庭/电话随访干预组还接受量身定制的运动方案、家庭访问和由老年护士进行的 24 周电话随访。仅运动和仅家庭/电话随访干预组除常规护理外，还分别仅接受干预措施中的运动或老年护士部分。数据收集在入院后 72 小时内的基线、出院后 4 周、出院后 12 周和出院后 24 周进行。结局评估者对分组情况不知情。主要结局是急诊再次入院和卫生服务使用、功能状态、心理社会幸福感和成本效益。
急性医院部门是发达国家医疗保健系统支出的最大组成部分，而老年人是最频繁的消费者。很少有试验证明有效的过渡性护理模式可以预防这一人群在急性住院后发生紧急再次入院、丧失功能能力和独立性。本研究旨在解决这一差距，并为未来的卫生服务规划提供信息，以满足客户需求并降低急性护理服务的使用。
澳大利亚和新西兰临床试验注册中心 ACTRN12608000202369。
