多模式干预改善家庭医疗环境中的骨质疏松症护理：一项群组随机试验的结果。
Multimodal intervention to improve osteoporosis care in home health settings: results from a cluster randomized trial.
机构信息
Department of Health Care Organization and Policy, University of Alabama at Birmingham (UAB), 1665 University Blvd, RPHB 330, Birmingham, AL, USA,
出版信息
Osteoporos Int. 2013 Oct;24(10):2555-60. doi: 10.1007/s00198-013-2340-7. Epub 2013 Mar 28.
SUMMARY
We conducted a cluster randomized trial testing the effectiveness of an intervention to increase the use of osteoporosis medications in high-risk patients receiving home health care. The trial did not find a significant difference in medication use in the intervention arm.
INTRODUCTION
This study aims to test an evidence implementation intervention to improve the quality of care in the home health care setting for patients at high risk for fractures.
METHODS
We conducted a cluster randomized trial of a multimodal intervention targeted at home care for high-risk patients (prior fracture or physician-diagnosed osteoporosis) receiving care in a statewide home health agency in Alabama. Offices throughout the state were randomized to receive the intervention or to usual care. The primary outcome was the proportion of high-risk home health patients treated with osteoporosis medications. A t test of difference in proportions was conducted between intervention and control arms and constituted the primary analysis. Secondary analyses included logistic regression estimating the effect of individual patients being treated in an intervention arm office on the likelihood of a patient receiving osteoporosis medications. A follow-on analysis examined the effect of an automated alert built into the electronic medical record that prompted the home health care nurses to deploy the intervention for high-risk patients using a pre-post design.
RESULTS
There were 11 offices randomized to each of the treatment and control arms; these offices treated 337 and 330 eligible patients, respectively. Among the offices in the intervention arm, the average proportion of eligible patients receiving osteoporosis medications post-intervention was 19.1 %, compared with 15.7 % in the usual care arm (difference in proportions 3.4 %, 95 % CI, -2.6 to 9.5 %). The overall rates of osteoporosis medication use increased from 14.8 % prior to activation of the automated alert to 17.6 % afterward, a nonsignificant difference.
CONCLUSIONS
The home health intervention did not result in a significant improvement in use of osteoporosis medications in high-risk patients.
摘要
我们进行了一项集群随机试验，以测试一项增加接受家庭保健的高风险患者使用骨质疏松症药物的干预措施的有效性。该试验未发现干预组药物使用的显著差异。
引言
本研究旨在测试一种证据实施干预措施，以改善家庭保健环境中骨折高风险患者的护理质量。
方法
我们对亚利桑那州一家全州性家庭保健机构的高风险患者（既往骨折或医生诊断为骨质疏松症）进行了一项多模式干预的集群随机试验。全州的办公室被随机分配接受干预或常规护理。主要结局是接受骨质疏松症药物治疗的高风险家庭保健患者的比例。采用比例差异 t 检验对干预组和对照组进行了分析，并构成了主要分析。次要分析包括逻辑回归，估计患者在干预组办公室接受治疗的个体患者对接受骨质疏松症药物治疗的可能性的影响。后续分析检查了电子病历中内置的自动警报对使用前后设计为高风险患者部署干预措施的家庭保健护士的影响。
结果
有 11 个办公室被随机分配到治疗组和对照组，分别治疗了 337 名和 330 名合格患者。在干预组的办公室中，接受骨质疏松症药物治疗的合格患者的平均比例为 19.1%，而常规护理组为 15.7%（比例差异 3.4%，95%CI，-2.6 至 9.5%）。在自动警报启动前后，骨质疏松症药物使用率从 14.8%增加到 17.6%，但差异无统计学意义。
结论
家庭保健干预并未显著改善高风险患者使用骨质疏松症药物的情况。
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