Boyd Michal, Armstrong Delwyn, Parker Janet, Pilcher Carole, Zhou Lifeng, McKenzie-Green Barbara, Connolly Martin J
Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand; School of Nursing, University of Auckland, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
J Am Geriatr Soc. 2014 Oct;62(10):1962-7. doi: 10.1111/jgs.13022. Epub 2014 Oct 3.
Residents of long-term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program (RACIP) is a quality improvement intervention to support residential aged care staff and includes on-site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists (GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio (RR) = 0.73, 95% confidence interval (CI) = 0.61-0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) (RR = 0.67, 95% CI = 0.56-0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups (RR = 1.0, 95% CI = 0.68-1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health.
长期护理机构的居民有着高度复杂的护理需求，护理质量是国际关注的问题。通过积极评估和早期干预来维持居民健康是减少急性住院需求的关键。老年护理整合项目（RACIP）是一项质量改进干预措施，旨在支持老年护理机构工作人员，包括由一个大型地区卫生委员会雇佣的老年护理护士专家（GNSs）提供的现场支持、教育、临床指导和护理协调。通过对项目实施前后1年的住院情况进行随机比较，评估了该外展项目的效果。样本包括29个干预机构（1425名居民）和25个接受常规护理的对照机构（1128名居民）。项目实施后，两组的急性住院率意外上升，不过干预机构的上升幅度明显较小。干预后，对照组的住院率上升了59%，干预组上升了16%（率比（RR）=0.73，95%置信区间（CI）=0.61 - 0.86，P<.001）。亚组分析显示，干预组因医疗原因入院者的率变化显著低于对照组（干预组上升13%，对照组上升69%）（RR = 0.67，95% CI = 0.56 - 0.82，P<.001）。相反，干预组和对照组手术入院的RR没有显著差异（RR = 1.0，95% CI = 0.68 - 1.46，P = 0.99）。通过RACIP干预整合GNS的专业知识可能是一种支持工作人员提供最佳护理并潜在改善居民健康的方法。
