Coleman E A, Barbaccia J C, Croughan-Minihane M S
University of California, School of Medicine, San Francisco.
J Am Geriatr Soc. 1990 Feb;38(2):108-12. doi: 10.1111/j.1532-5415.1990.tb03470.x.
Although Special Care Units (SCUs) have recently gained attention as appropriate places for caring for institutionalized patients with dementia, few studies have evaluated their effectiveness. This pilot study focused primarily on one aspect of patient care, the possible prevention of acute hospitalization. Because transfer from nursing home to the acute hospital can be a traumatic experience for patients with dementia, important services that SCUs might provide include those preventive strategies aimed at reducing the need for transfer to the acute hospital. Medical record abstraction revealed that over one year, the rate of acute hospitalization was 21% among 47 patients with dementia in SCUs, compared with 14% among 36 patients with dementia and 14% among 22 patients with no listed diagnosis of dementia residing in non-SCU settings within the same facility. Thus, no statistically significant difference in hospitalization rates was found, although the trend was for increased hospitalization for SCU patients. There was a trend toward deterioration in functional status among SCU patients following first hospitalization (P less than .10). Since the majority of these patients were hospitalized for hip fractures, this finding was not unexpected. There was a trend toward cognitive decline after hospitalization among patients with dementia who were not residing in an SCU (P less than .10). In order to investigate whether acute hospitalizations among SCU patients were preventable, an expert panel was convened to review each episode of illness leading to acute hospitalization. Of the 15 hospitalizations, none were judged "preventable," four were believed to be "possibly preventable," and 11 were considered to have been "not preventable."(ABSTRACT TRUNCATED AT 250 WORDS)
尽管特殊护理单元（SCUs）最近作为照料患有痴呆症的机构化患者的合适场所而受到关注，但很少有研究评估其有效性。这项试点研究主要关注患者护理的一个方面，即可能预防急性住院。由于从疗养院转到急症医院对痴呆症患者来说可能是一次痛苦的经历，SCUs可能提供的重要服务包括那些旨在减少转往急症医院需求的预防策略。病历摘要显示，在一年多的时间里，47名住在SCUs的痴呆症患者的急性住院率为21%，相比之下，住在同一机构非SCU环境中的36名痴呆症患者的急性住院率为14%，22名未列出痴呆症诊断的患者的急性住院率为14%。因此，尽管趋势是SCU患者的住院率有所上升，但未发现住院率有统计学上的显著差异。首次住院后，SCU患者的功能状态有恶化趋势（P小于0.10）。由于这些患者大多数因髋部骨折住院，这一发现并不意外。不住在SCU的痴呆症患者住院后有认知能力下降的趋势（P小于0.10）。为了调查SCU患者的急性住院是否可以预防，召集了一个专家小组来审查导致急性住院的每一次发病情况。在这15次住院病例中，没有一例被判定为“可预防”，4例被认为“可能可预防”，11例被认为“不可预防”。（摘要截选至250字）
