Department of Medicine, Division of Hospital Medicine, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA.
Department of Medicine, Division of Geriatric & Palliative Medicine, Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA.
Arch Gerontol Geriatr. 2018 Jul-Aug;77:31-37. doi: 10.1016/j.archger.2018.03.006. Epub 2018 Mar 16.
Medicare patients account for over 50% of hospital days at a cost of over $1 trillion per year. Yet, hospitalization of older adults often results in poor outcomes. We evaluated the role of geriatrician-hospitalists in the care of older adults. Materials and methods A retrospective cohort study was conducted in a 764-bed tertiary care hospital with patients 65 and older admitted to medicine. Geriatrician-hospitalists care was compared to usual care by non-geriatrician hospitalists (staff and non-staff). Outcome measures included length of stay (LOS) and 30-day readmissions. Process measures included geriatric-focused care practices, such as early mobilization, safety precautions, delirium management, use of potentially inappropriate medications and documentation of advanced directives as well as discharge disposition.
Of the 10,529 patients, 2949 (28.0%) were cared for by staff hospitalists, 7181 (68.2%) by non-staff hospitalists and 399 (3.79%) by geriatrician-hospitalists. Patients cared for by geriatrician-hospitalists were significantly older with more comorbidities than those admitted to staff and non-staff hospitalists (average age: 86.3, 79.7, and 80.3, respectively, p < 0.0001; Charlson Comorbidity Index: 7.46, 7.01, and 7.17, respectively, p = 0.0005). Multivariate analysis showed no difference in LOS, 30-day readmissions, and discharge disposition. In terms of care practices, significant differences were found for the following: time to PT (p < 0.0001), duration of indwelling bladder catheters (p = 0.018), documentation of Do-Not-Resuscitate (p < 0.0001), benzodiazepine use (p < 0.0001) and anticholinergics (p = 0.0029), respectively.
As the population continues to age at unprecedented rates and hospitals struggle to meet the demands and expectations, geriatrician-hospitalists may improve care practices important for older adult care management.
医疗保险患者占医院住院日的 50%以上，每年的费用超过 1 万亿美元。然而，老年人的住院治疗往往导致预后不良。我们评估了老年病医生-医院医师在老年人护理中的作用。
这是一项在一家拥有 764 张床位的三级保健医院进行的回顾性队列研究，患者年龄在 65 岁及以上，被收入内科。老年病医生-医院医师的治疗与非老年病医生-医院医师（工作人员和非工作人员）的常规治疗进行了比较。
在 10529 名患者中，2949 名（28.0%）由工作人员医院医师治疗，7181 名（68.2%）由非工作人员医院医师治疗，399 名（3.79%）由老年病医生-医院医师治疗。与工作人员和非工作人员医院医师收治的患者相比，由老年病医生-医院医师收治的患者年龄明显更大，合并症更多（平均年龄：86.3、79.7 和 80.3，分别，p < 0.0001；Charlson 合并症指数：7.46、7.01 和 7.17，分别，p = 0.0005）。多变量分析显示，住院时间、30 天再入院率和出院处置无差异。在护理实践方面，以下方面存在显著差异：物理治疗开始时间（p < 0.0001）、留置导尿管时间（p = 0.018）、不复苏医嘱记录（p < 0.0001）、苯二氮䓬类药物使用（p < 0.0001）和抗胆碱能药物（p = 0.0029）。
随着人口以前所未有的速度老龄化，医院努力满足需求和期望，老年病医生-医院医师可能会改善对老年患者护理管理重要的护理实践。
