Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg 40530, Sweden.
Eur Heart J. 2012 May;33(9):1112-9. doi: 10.1093/eurheartj/ehr306. Epub 2011 Sep 15.
Person-centred care (PCC) emphasizes a partnership in care between patients and healthcare professionals and is advocated by WHO as a key component of quality health care. We evaluated outcomes of PCC in hospitalized patients with chronic heart failure (CHF) with respect to the length of hospital stay (LOS), activities of daily living (ADL), health-related quality of life (HRQL) and 6-month readmission rate.
During 2008-2010, 248 consecutive patients hospitalized for symptoms of worsening CHF were enrolled in a controlled before and after designed study. A Usual care group (n= 123) was recruited according to pre-defined criteria to map usual CHF care and assess outcomes at five designated hospital wards. Based on the mapping, a panel of in-house clinicians and researchers developed measures aimed at aligning usual care with basic PCC principles. These measures were incorporated into a study protocol to guide care procedures at the same five wards. Person-centred care was then implemented at these wards and evaluated in 125 patients. Both length of hospital stay and 6-month readmission were extracted from patient records. Activities of daily living were evaluated at baseline and discharge and HRQL was evaluated at baseline and after 3 months. In the analysis of all patients, the LOS was reduced by 1 day (P = 0.16) while retaining ADL (P = 0.07). When PCC was fully implemented (per protocol analysis), LOS was reduced by 2.5 days (P = 0.01) and the ADL-level better preserved (P = 0.04). Health-related quality of life and time-to-first readmission did not differ.
In this proof-of-concept study, our findings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalized for worsening CHF, without increasing risk for readmission or jeopardizing patients' HRQL.
以患者为中心的护理（PCC）强调患者与医疗保健专业人员之间的护理伙伴关系，世卫组织倡导将其作为优质医疗保健的关键组成部分。我们评估了 PCC 对慢性心力衰竭（CHF）住院患者的结局，包括住院时间（LOS）、日常生活活动（ADL）、健康相关生活质量（HRQL）和 6 个月再入院率。
在 2008 年至 2010 年间，我们对 248 名因 CHF 恶化症状而住院的连续患者进行了一项对照前后设计的研究。根据预先确定的标准招募了一组常规护理组（n=123），以绘制常规 CHF 护理图并在五个指定的医院病房评估结果。基于该映射，一组内部临床医生和研究人员制定了旨在使常规护理与基本 PCC 原则保持一致的措施。这些措施被纳入研究方案，以指导相同五个病房的护理程序。然后在这些病房实施以患者为中心的护理，并在 125 名患者中进行评估。所有患者的住院时间和 6 个月的再入院率均从病历中提取。ADL 在基线和出院时进行评估，HRQL 在基线和 3 个月后进行评估。在所有患者的分析中，住院时间缩短了 1 天（P=0.16），同时保留了 ADL（P=0.07）。当完全实施 PCC 时（按方案分析），住院时间缩短了 2.5 天（P=0.01），并且 ADL 水平得到更好的维持（P=0.04）。HRQL 和首次再入院时间没有差异。
在这项概念验证研究中，我们的发现表明，全面实施的 PCC 方法可以缩短因 CHF 恶化而住院的患者的住院时间并维持其功能表现，而不会增加再入院的风险或危及患者的 HRQL。
