Severinsen Kyle D, Tufton Anne, Hannan Emma, Schwind Jessica S, Schmucker Dana, Cutler Allison
The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
The University of Queensland School of Medicine, Brisbane, Queensland, Australia.
Ochsner J. 2015 Winter;15(4):423-8.
Hospital-associated disability is the loss of the ability to complete one activity of daily living (ADL), with this decline occurring between the onset of acute illness and discharge from the hospital. Approximately 30% of patients who are >70 years old and admitted to hospitals are discharged with an ADL disability. Comprehensive geriatric assessment (CGA) models use a multidimensional, interdisciplinary process of diagnosis and treatment with the goal of improving outcomes and decreasing lengths of stay.
A retrospective clinical audit of Ipswich Hospital's medical records included patients for random selection who were >75 years of age and had an acute admission to the Older Person Evaluation Review and Assessment (OPERA) or general medicine (GM) service from July 2012 to December 2012. Data were collected for the entire admission period on length of stay, comorbidities, allied health visits, functional ability, and delirium and dementia at admission.
Of the 267 patients evaluated, 133 were admitted to the OPERA service, and 134 were admitted to the GM service. Patients admitted to the OPERA service were significantly more ill than patients admitted to the GM service as measured by the Charlson Comorbidity Index scores (6.53 ± 1.83 vs 6.02 ± 1.96, respectively, P=0.02), Katz Index of Independence in ADL scores (3.77 ± 2.22 vs 4.72 ± 2.00, respectively, P<0.001), presence of delirium at admission (28% vs 15%, respectively, P=0.02), and presence of dementia at admission (42% vs 21%, respectively, P=0.002). However, patients in both groups had a mean acute length of stay of 4 days (P=0.33), the readmission rate was <20% for both groups (P=0.33), and the mortality rate for each group was similar (3%).
By showing that patients admitted to the OPERA service were more ill than patients admitted to the GM service but health outcomes were maintained, researchers hope to justify the need for such CGA models. Additional goals include garnering support for the maintenance and growth of CGA models; decreasing mortality, cost, and readmission rates; and improving the quality of life for older patients.
医院获得性残疾是指在急性疾病发作至出院期间丧失完成一项日常生活活动（ADL）的能力。年龄大于70岁且入院的患者中，约30%出院时存在ADL残疾。综合老年评估（CGA）模型采用多维度、跨学科的诊断和治疗过程，目标是改善治疗效果并缩短住院时间。
对伊普斯威奇医院的病历进行回顾性临床审计，随机选择2012年7月至2012年12月期间年龄大于75岁且急性入住老年人评估审查与评估（OPERA）或普通内科（GM）服务的患者。收集整个住院期间的住院时间、合并症、联合健康护理就诊、功能能力以及入院时的谵妄和痴呆情况的数据。
在评估的267例患者中，133例入住OPERA服务，134例入住GM服务。根据查尔森合并症指数评分（分别为6.53±1.83和6.02±1.96，P = 0.02）、ADL的卡茨独立性指数评分（分别为3.77±2.22和4.72±2.00，P<0.001）、入院时谵妄的存在情况（分别为28%和15%，P = 0.02）以及入院时痴呆的存在情况（分别为42%和21%，P = 0.002）衡量，入住OPERA服务的患者比入住GM服务的患者病情严重得多。然而，两组患者的平均急性住院时间均为4天（P = 0.33），两组的再入院率均<20%（P = 0.33），且每组的死亡率相似（3%）。
通过表明入住OPERA服务的患者比入住GM服务的患者病情更严重，但健康结局得以维持，研究人员希望证明此类CGA模型的必要性。其他目标包括为CGA模型的维持和发展争取支持；降低死亡率、成本和再入院率；以及改善老年患者的生活质量。
