Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal (QC), Canada.
J Am Med Dir Assoc. 2012 Oct;13(8):739-43. doi: 10.1016/j.jamda.2012.07.007. Epub 2012 Aug 20.
To identify the structural and patient characteristics associated with better care processes in older vulnerable hospitalized patients.
Retrospective study.
Forty-four Geriatric Assessment Units (GAU).
Patients aged 65 and older who were admitted to a GAU for a fall with trauma.
Three care processes (comprehensiveness, informational continuity, completion of advance health care directives) assessed through chart audit; 14 patient- and 23 GAU-related characteristics obtained from hospitalization records, national databases, and GAU managers.
A total of 877 hospitalization records were included. Final models were based on multilevel modeling using stepwise variable selection. Strongest predictors of better comprehensiveness were longer hospital length of stay (LOS), higher clinical complexity (eg, higher mortality risk), and having a geriatrician as attending physician. Comprehensiveness score increased sharply up to 3 weeks LOS and then tended to plateau. Better informational continuity was associated with more comprehensive care, higher risk of mortality, acute rather than rehabilitation care, communication with community health care professionals within 48 hours after admission, and a target LOS of 3 weeks or longer. The completion of advance directives was more likely in the presence of advanced age, higher risk of mortality, cognitive impairment, discharge to another care facility, longer LOS, university-affiliated institution, and nonurban location.
In GAUs, quality-of-care processes are related to both structural and patient characteristics. Our results pointed toward an organizational framework that may help to streamline the geriatric units and better use resources, notably by narrowing the admission criteria, targeting a proper LOS, improving communication with community organizations, and making systematic completion of advance directives.
确定与老年脆弱住院患者更好的护理过程相关的结构和患者特征。
回顾性研究。
44 个老年评估单位（GAU）。
因创伤而跌倒并被收治到 GAU 的 65 岁及以上患者。
通过病历审核评估三个护理过程（全面性、信息连续性、预先医疗保健指令的完成）；从住院记录、国家数据库和 GAU 管理人员处获得 14 项患者和 23 项 GAU 相关特征。
共纳入 877 份住院记录。最终模型基于使用逐步变量选择的多水平建模。全面性更好的最强预测因素是住院时间（LOS）较长、临床复杂性较高（例如，死亡率风险较高）以及主治医生为老年医生。全面性评分在 LOS 达到 3 周之前急剧上升，然后趋于平稳。更好的信息连续性与更全面的护理相关，与死亡率风险较高、急性而非康复护理相关，入院后 48 小时内与社区卫生保健专业人员进行沟通，以及目标 LOS 为 3 周或更长。在高龄、死亡率风险较高、认知障碍、转至其他护理机构、住院时间较长、大学附属机构和非城市地区存在的情况下，更有可能完成预先指令。
在 GAU 中，护理质量过程与结构和患者特征都有关。我们的研究结果指出了一个组织框架，该框架可以帮助简化老年病房，并更好地利用资源，特别是通过缩小入院标准、确定适当的 LOS、改善与社区组织的沟通以及系统地完成预先指令。
