Fernández Alonso C, Fuentes Ferrer M, Jiménez Santana M I, Fernández Hernández L, de la Cruz García M, González Del Castillo J, González Armengol J J, Gil Gregorio P, Calvo Manuel E, Martín-Sánchez F J
Servicio de Urgencias, Unidad de Corta Estancia, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital San Carlos, Facultad de Ciencias de la Salud, Universidad Alfonso X el Sabio, Madrid, España.
Rev Clin Esp (Barc). 2018 May;218(4):163-169. doi: 10.1016/j.rce.2018.01.008. Epub 2018 Feb 27.
To study the effect of a multidimensional intervention on the prognosis at 30 days for frail elderly patients discharged from a short-stay unit.
A quasiexperimental study was conducted with a historical control cohort. We included frail patients (Identification of Seniors at Risk score≥2) 75 years of age or older, discharged from an short-stay unit over 2 months in 2013 (control group) and in 2016 (intervention group). An intervention was conducted based on the activation of resources, based on the deficiencies detected after an abbreviated geriatric assessment, in conjunction with Primary Care. The main endpoint was the presence of an adverse result (death or readmission for any cause or severe functional impairment) at 30 days of discharge.
We included 137 (62.8%) patients in the intervention group and 81 (37.2%) in the control group. Eighteen (13.1%) patients in the intervention group and 29 (35.8%) in the control group presented an adverse event at 30 days. A multivariate analysis showed that the implementation of a multidimensional intervention was a protective factor for presenting an adverse event at 30 days of discharge (adjusted RR 0.40; 95% CI 0.23-0.68; P=.001).
The implementation of an individual care plan for frail elderly patients, based on the activation of resources according to the deficiencies detected after an abbreviated geriatric assessment and in conjunction with Primary Care, could improve the results at 30 days of discharge from an short-stay unit.
研究多维度干预对短期住院单元出院的体弱老年患者30天预后的影响。
采用历史对照队列进行准实验研究。纳入2013年（对照组）和2016年（干预组）从短期住院单元出院的75岁及以上体弱患者（老年人风险识别评分≥2）。根据简易老年评估后发现的缺陷，结合初级保健，基于资源激活进行干预。主要终点是出院30天时出现不良结果（因任何原因死亡或再次入院或严重功能障碍）。
干预组纳入137例患者（62.8%），对照组纳入81例患者（37.2%）。干预组18例患者（13.1%）和对照组29例患者（35.8%）在30天时出现不良事件。多变量分析显示，实施多维度干预是出院30天时出现不良事件的保护因素（调整后RR 0.40；95%CI 0.23 - 0.68；P = 0.001）。
基于简易老年评估后发现的缺陷并结合初级保健激活资源，为体弱老年患者实施个性化护理计划，可改善短期住院单元出院30天时的预后。
