Fan Lijun, Lukin William, Zhao Jingzhou, Sun Jiandong, Hou Xiang-Yu
School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Emerg Med J. 2015 Sep;32(9):738-43. doi: 10.1136/emermed-2014-203770. Epub 2014 Dec 19.
High utilisation of emergency department (ED) among the elderly is of worldwide concern. This study aims to review the effectiveness of interventions targeting the elderly population in reducing ED utilisation.
Major biomedical databases were searched for relevant studies. Qualitative approach was applied to derive common themes in the myriad interventions and to critically assess the variations influencing interventions' effectiveness. Quality of studies was appraised using the Effective Public Health Practice Project (EPPHP) tool.
36 studies were included. Nine of 16 community-based interventions reported significant reductions in ED utilisation. Five of 20 hospital-based interventions proved effective while another four demonstrated failure. Seven key elements were identified. Ten of 14 interventions associated with significant reduction on ED use integrated at least three of the seven elements. All four interventions with significant negative results lacked five or more of the seven elements. Some key elements including multidisciplinary team, integrated primary care and social care often existed in effective interventions, while were absent in all significantly ineffective ones.
The investigated interventions have mixed effectiveness. Our findings suggest the hospital-based interventions have relatively poorer effects, and should be better connected to the community-based strategies. Interventions seem to achieve the most success with integration of multi-layered elements, especially when incorporating key elements such as a nurse-led multidisciplinary team, integrated social care, and strong linkages to the longer-term primary and community care. Notwithstanding limitations in generalising the findings, this review builds on the growing body of evidence in this particular area.
老年人急诊室（ED）的高利用率是全球关注的问题。本研究旨在回顾针对老年人群体的干预措施在降低急诊室利用率方面的有效性。
检索主要生物医学数据库以查找相关研究。采用定性方法来归纳众多干预措施中的共同主题，并批判性地评估影响干预措施有效性的差异。使用有效公共卫生实践项目（EPPHP）工具评估研究质量。
纳入36项研究。16项基于社区的干预措施中有9项报告急诊室利用率显著降低。20项基于医院的干预措施中有5项被证明有效，另外4项则无效。确定了7个关键要素。14项与急诊室使用显著减少相关的干预措施中有10项整合了7个要素中的至少3个。所有4项产生显著负面结果的干预措施都缺少7个要素中的5个或更多。一些关键要素，包括多学科团队、综合初级保健和社会护理，在有效的干预措施中经常存在，而在所有显著无效的干预措施中都不存在。
所调查的干预措施效果不一。我们的研究结果表明，基于医院的干预措施效果相对较差，应更好地与基于社区的策略相联系。干预措施似乎在整合多层次要素时最为成功，特别是在纳入诸如护士主导的多学科团队、综合社会护理以及与长期初级和社区护理的紧密联系等关键要素时。尽管在将研究结果推广方面存在局限性，但本综述建立在该特定领域不断增加的证据基础之上。
