Moorhouse Paige, Theou Olga, Fay Sherri, McMillan Miranda, Moffatt Heather, Rockwood Kenneth
Division of Geriatric Medicine, Dalhousie University, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada.
Centre for Health Care of the Elderly, Nova Scotia Health Authority, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada.
BMC Geriatr. 2017 Jan 7;17(1):9. doi: 10.1186/s12877-016-0397-9.
Evidence regarding outcomes in the Geriatric Day Hospital (GDH) model of care has been largely inconclusive, possibly due to measurement issues. This prospective cohort study aims to determine whether treatment in a GDH could improve individualized outcome measures using goal attainment scaling (GAS) and whether improvements are maintained 6-months post-discharge.
A total of 469 outpatients admitted to a Canadian Geriatric Day Hospital, between December 2008 and June 2011, were included in the analysis (81.1 ± 6.7 years, 66.3% females); a smaller cohort of 121 patients received a follow-up phone call 6 months following discharge. Baseline, discharge and 6 month post-discharge observer-rated measures of mobility, cognition, and function were completed using GAS. Traditional psychometric measures were also captured.
The mean number of goals set was 1.6 (SD 0.8) and patients set goals in the following domains: 88% mobility or falls reduction; 18% optimization of home supports; 17% medication optimization;12% cognition; 8% increasing social engagement; and 5% optimization of function. Total GAS was the most responsive measure to change with 86% of patients improving at discharge; mobility goals were the most likely to be achieved. Six-month GAS scores remained significantly higher than GAS scores on admission. Those who had more goals were more likely to improve during GDH admission (OR 1.49, CI 1.02-2.19) but this association was not seen 6 months after discharge.
This study demonstrated short- and long-term effectiveness of GDH in helping patients achieve individualized outcome measures using GAS.
老年日间医院（GDH）护理模式的效果证据大多尚无定论，可能是由于测量问题。这项前瞻性队列研究旨在确定在GDH接受治疗是否能使用目标达成量表（GAS）改善个体化结局指标，以及出院后6个月这些改善是否能持续。
纳入2008年12月至2011年6月期间入住加拿大老年日间医院的469名门诊患者进行分析（年龄81.1±6.7岁，女性占66.3%）；一小群121名患者在出院后6个月接受了随访电话。使用GAS完成了基线、出院时和出院后6个月的观察者评定的活动能力、认知和功能指标。还收集了传统的心理测量指标。
设定的目标平均数量为1.6个（标准差0.8），患者设定的目标涉及以下领域：88%为活动能力或减少跌倒；18%为优化家庭支持；17%为优化用药；12%为认知；8%为增加社交参与；5%为优化功能。总GAS是对变化最敏感的指标，86%的患者在出院时有所改善；活动能力目标最有可能实现。6个月时的GAS评分仍显著高于入院时的GAS评分。目标较多的患者在GDH住院期间更有可能改善（比值比1.49，可信区间1.02 - 2.19），但出院后6个月未观察到这种关联。
本研究证明了GDH在帮助患者使用GAS实现个体化结局指标方面的短期和长期有效性。
