Lindegaard Pedersen J, Pedersen P U, Damsgaard E M
Jette Lindegaard Pedersen, Clinical research nurse, Aarhus University Hospital, Geriatrics, P.P. Oerumsgade 11, Aarhus, 8000, Denmark, 0045 40256721,
J Nutr Health Aging. 2017;21(1):75-82. doi: 10.1007/s12603-016-0745-7.
To compare the effects of two individualized nutritional follow-up intervention strategies (home visit or telephone consultation) with no follow-up, with regard to acute readmissions to hospital at two points in time, 30 and 90 days after discharge from hospital.
Randomized clinical trial with two intervention groups and one control group, and monitoring on readmission at 30 and 90 days after discharge.
Intervention in the participants' homes after discharge from hospital.
Inclusion: Malnourished geriatric patients and patients at risk of malnutrition (MNA<24), aged 75 years and older, living at home and alone. Exclusion: Nursing home residents and patients with terminal illnesses or cognitive impairment. Randomization: Upon discharge, the patients were stratified according to nutritional status (MNA), and assigned to one of three groups: 'home visit', 'telephone', or 'control' group.
Individualized nutritional counselling of the patient and the patient's daily home carer by a clinical dietician one, two, and four weeks after discharge from hospital. The counselling was either in-person at the patient's homes, or over the telephone. All patients received a diet plan on discharge. The control group received standard care, but no follow-up after discharge.
Information on readmissions to hospital and mortality at 30 and 90 days after discharge was obtained from electronic patient records. Intention-to-treat (ITT) and per-protocol (PP) analyses were carried out.
Two-hundred and eight participants were randomized, 73 to home visits, 68 to the telephone consultation group, and 67 to the control group. The mean age of the participants was 86.1 years. Home visit participants had a lower risk of readmission to hospital compared to control participants at 30 days after discharge (HR=0.4; 95% CI: 0.2-0.9, p=0.03) and 90 days after discharge (HR=0.4; 95% CI: 0.2-0.8, p<0.01). No significant difference was detected between the telephone consultation group and the control group, at either 30 days (HR=0.6, 95% CI: 0.3-1.3, p=0.18) or 90 days after discharge (HR=0.7, 95% CI: 0.4-1.3, p=0.23). The PP analysis revealed that the risk of readmission was significantly lower in the home visit group compared to the control group and the telephone consultation group compared to the control group, and this was evident at 30 days as well as at 90 days after discharge.
An individualized nutritional follow-up performed as home visits seems to reduce readmission to hospital 30 and 90 days after discharge. Intervention by telephone consultations may also prevent readmission, but only among participants who receive the full intervention.
比较两种个性化营养随访干预策略（家访或电话咨询）与无随访措施相比，在出院后30天和90天这两个时间点的急性再入院情况。
随机临床试验，设有两个干预组和一个对照组，并对出院后30天和90天的再入院情况进行监测。
出院后在参与者家中进行干预。
纳入标准：年龄在75岁及以上、独居在家的营养不良老年患者和有营养不良风险的患者（微型营养评定法评分<24）。排除标准：养老院居民以及患有晚期疾病或认知障碍的患者。随机分组：出院时，患者根据营养状况（微型营养评定法评分）分层，然后被分配到三个组之一：“家访”组、“电话”组或“对照组”。
出院后1周、2周和4周，由临床营养师对患者及其日常家庭护理人员进行个性化营养咨询。咨询方式为亲自到患者家中或通过电话进行。所有患者出院时均收到一份饮食计划。对照组接受标准护理，但出院后无随访。
从电子病历中获取出院后30天和90天的再入院信息和死亡率。进行意向性分析（ITT）和符合方案分析（PP）。
208名参与者被随机分组，73人分到家访组，68人分到电话咨询组，67人分到对照组。参与者的平均年龄为86.1岁。家访组参与者在出院后30天（风险比[HR]=0.4；95%置信区间[CI]：0.2 - 0.9，p=0.03）和90天（HR=0.4；95% CI：0.2 - 0.8，p<0.01）的再入院风险低于对照组参与者。电话咨询组与对照组在出院后30天（HR=0.6，95% CI：0.3 - 1.3，p=0.18）或90天（HR=0.7，95% CI：0.4 - 1.3，p=0.23）均未检测到显著差异。符合方案分析显示，家访组的再入院风险显著低于对照组，电话咨询组与对照组相比也是如此，这在出院后30天和90天均很明显。
以家访形式进行的个性化营养随访似乎可降低出院后30天和90天的再入院率。电话咨询干预也可能预防再入院，但仅在接受完整干预的参与者中有效。
