Toles Mark, Moriarty Helene, Coburn Ken, Marcantonio Sherry, Hanlon Alexandra, Mauer Elizabeth, Fisher Paige, O'Connor Melissa, Ulrich Connie, Naylor Mary D
1 University of North Carolina at Chapel Hill, USA.
2 Villanova University, PA, USA.
J Appl Gerontol. 2017 Apr;36(4):462-479. doi: 10.1177/0733464815602115. Epub 2016 Jul 9.
Models of care coordination can significantly improve health outcomes for older adults with chronic illnesses if they can engage participants. The purpose of this study was to examine the impact of nursing contact on the rate of participants' voluntary disenrollment from a care coordination program. In this retrospective cohort study using administrative data for 1,524 participants in the Health Quality Partners Medicare Care Coordination Demonstration Program, the rate of voluntary disenrollment was approximately 11%. A lower risk of voluntary disenrollment was associated with a greater proportion of in-person (vs. telephonic) nursing contact (Hazard Ratio [HR] 0.137, confidence interval [CI] [0.050, 0.376]). A higher risk of voluntary disenrollment was associated with lower continuity of nurses who provided care (HR 1.964, CI [1.724, 2.238]). Findings suggest that in-person nursing contact and care continuity may enhance enrollment of chronically ill older adults and, ultimately, the overall health and well-being of this population.
如果能让参与者参与进来，护理协调模式可以显著改善患有慢性疾病的老年人的健康状况。本研究的目的是检验护理接触对护理协调项目参与者自愿退出率的影响。在这项回顾性队列研究中，使用了健康质量伙伴医疗保险护理协调示范项目中1524名参与者的行政数据，自愿退出率约为11%。亲自（而非通过电话）护理接触比例越高，自愿退出风险越低（风险比[HR]0.137，置信区间[CI][0.050,0.376]）。提供护理的护士连续性越低，自愿退出风险越高（HR 1.964，CI[1.724,2.238]）。研究结果表明，亲自护理接触和护理连续性可能会提高慢性病老年人的参与率，并最终改善这一人群的整体健康和福祉。
