Martin-Khan Melinda G, Edwards Helen, Wootton Richard, Counsell Steven R, Varghese Paul, Lim Wen Kwang, Darzins Peteris, Dakin Lucy, Klein Kerenaftali, Gray Leonard C
Centre for Research in Geriatric Medicine, University of Queensland, Woolloongabba, Queensland, Australia.
Centre for Online Health, The University of Queensland, Woolloongabba, Queensland, Australia.
J Am Geriatr Soc. 2017 Sep;65(9):2029-2036. doi: 10.1111/jgs.14895. Epub 2017 Aug 21.
To determine whether geriatric triage decisions made using a comprehensive geriatric assessment (CGA) performed online are less reliable than face-to-face (FTF) decisions.
Multisite noninferiority prospective cohort study. Two specialist geriatricians assessed individuals sequentially referred for an acute care geriatric consultation. Participants were allocated to one FTF assessment and an additional assessment (FTF or online (OL)), creating two groups-two FTF (FTF-FTF, n = 81) or online and FTF (OL-FTF, n = 85).
Three acute care public hospitals in two Australian states.
Admitted individuals referred for CGA.
Nurse-administered CGA, based on the interRAI Acute Care assessment system accessed online and other online clinical data such as pathology results and imaging enabling geriatricians to review participants' information and provide input into their care from a distance.
The primary decision subjected to this analysis was referral for permanent residential care. Geriatricians also recorded recommendations for referrals and variations for medication management and judgment regarding prognosis at discharge and after 3 months.
Overall percentage agreement was 88% (n = 71) for the FTF-FTF group and 91% (n = 77) for the OL-FTF group. The difference in agreement between the FTF-FTF and OL-FTF groups was -3%, indicating that there was no difference between the methods of assessment. Judgements made regarding diagnoses of geriatric syndromes, medication management, and prognosis (with regard to hospital outcome and location at 3 months) were found to be equally reliable in each mode of consultation.
Geriatric assessment performed online using a nurse-administered structured CGA system was no less reliable than conventional assessment in making clinical triage decisions.
确定使用在线综合老年评估（CGA）做出的老年分诊决策是否比面对面（FTF）决策可靠性更低。
多中心非劣效性前瞻性队列研究。两名老年专科医生对依次转诊进行急性护理老年咨询的个体进行评估。参与者被分配接受一次面对面评估和一次额外评估（面对面或在线（OL）），从而形成两组——两次面对面（FTF-FTF，n = 81）或在线和面对面（OL-FTF，n = 85）。
澳大利亚两个州的三家急性护理公立医院。
被转诊进行CGA的住院个体。
由护士管理的CGA，基于在线访问的interRAI急性护理评估系统以及其他在线临床数据，如病理结果和影像学资料，使老年专科医生能够查看参与者的信息并远程对其护理提供意见。
本次分析的主要决策是是否转诊至永久性居住护理机构。老年专科医生还记录了转诊建议、药物管理方面的差异以及出院时和3个月后的预后判断。
FTF-FTF组的总体一致性百分比为88%（n = 71），OL-FTF组为91%（n = 77）。FTF-FTF组和OL-FTF组之间的一致性差异为-3%，表明两种评估方法之间没有差异。发现在每种咨询模式下，关于老年综合征诊断、药物管理以及预后（关于医院结局和3个月时的位置）的判断同样可靠。
使用护士管理的结构化CGA系统进行的在线老年评估在做出临床分诊决策时与传统评估一样可靠。
