Section of Movement Disorders, Department of Neurological Sciences, Rush Medical College, Rush Medical University, Chicago, Illinois.
Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, Department of Neurology, School of Medicine, New York University, New York, New York.
J Am Geriatr Soc. 2018 Jul;66(6):1226-1232. doi: 10.1111/jgs.15337. Epub 2018 Apr 2.
Parkinson's disease (PD) is a complex, multisymptom, neurodegenerative disease affecting primarily older adults. With progression, many individuals become homebound and removed from coordinated, expert care, resulting in excess morbidity, mortality, and healthcare expenditures in acute care settings and institutions. Home visit care models have achieved the triple aim of improving individual and population health while reducing costs in many frail, community-dwelling geriatric cohorts. This study details a novel, interdisciplinary home visit program specifically designed for individuals with PD and related disorders and their family caregivers built upon best practice principles in the care of multimorbid older adults. At each quarterly home visit, a movement disorders-trained neurologist, social worker, and nurse work in parallel with the individual and caregiver to complete a history, physical, detailed medication reconciliation, psychosocial needs assessment, and home safety assessment. A comprehensive, person-centered plan is agreed upon, referrals to community resources are made, standardized documentation is shared, and follow-up communication is instituted. In the first 2 years, 272 visits were conducted with 85 individuals who represent one of the oldest, most disabled PD populations reported. Satisfaction with and retention in the program were high. This study represents the first translation of the success of interdisciplinary and home-based geriatric care models to a population with a specific neurological disease. Preliminary evidence supports the need for such programs in vulnerable populations. Future studies will prospectively assess person-centered outcomes, the effect of using telemedicine on sustainability, and cost effectiveness.
帕金森病（PD）是一种复杂的、多症状的神经退行性疾病，主要影响老年人。随着疾病的进展，许多患者无法行动，无法获得协调、专业的护理，导致在急性护理环境和机构中出现过多的发病率、死亡率和医疗保健支出。家庭访视护理模式在许多虚弱的、居住在社区的老年人群中实现了改善个体和人群健康、降低成本的三重目标。本研究详细介绍了一种针对 PD 患者及其相关疾病患者及其家庭照顾者的新型跨学科家庭访视计划，该计划基于多病共存老年人护理的最佳实践原则。在每季度的家庭访视中，一名运动障碍训练有素的神经科医生、社会工作者和护士与个人和照顾者一起并行工作，完成病史、体检、详细的药物重整、社会心理需求评估和家庭安全评估。制定全面的、以个人为中心的计划，向社区资源转介，共享标准化文档，并进行随访沟通。在最初的 2 年里，共进行了 272 次访视，涉及 85 名患者，他们代表了报告的最古老、最残疾的 PD 人群之一。对该计划的满意度和保留率都很高。本研究首次将跨学科和基于家庭的老年护理模式的成功经验应用于特定的神经疾病人群。初步证据支持在弱势群体中开展此类项目的必要性。未来的研究将前瞻性评估以患者为中心的结果、使用远程医疗对可持续性的影响以及成本效益。
