“痴呆症护理伙伴”护理协调项目对退伍军人住院和急诊就诊的影响。
Impact of the care coordination program "Partners in Dementia Care" on veterans' hospital admissions and emergency department visits.
作者信息
Bass David M, Judge Katherine S, Maslow Katie, Wilson Nancy L, Morgan Robert O, McCarthy Catherine A, Looman Wendy J, Snow A Lynn, Kunik Mark E
机构信息
Benjamin Rose Institute on Aging, Cleveland, OH, USA.
Department of Psychology, Cleveland State University, Cleveland, OH, USA.
出版信息
Alzheimers Dement (N Y). 2015 Apr 17;1(1):13-22. doi: 10.1016/j.trci.2015.03.003. eCollection 2015 Jun.
INTRODUCTION
"Partners in Dementia Care" (PDC) tested a care-coordination program based on partnerships between Veterans Affairs (VA) medical centers and Alzheimer's Association chapters. The hypothesis posited PDC would reduce the likelihood and number of veterans' hospital admissions and emergency department (ED) visits, particularly for those with more cognitive impairment or behavioral symptoms.
METHODS
The sample included 328 veterans with dementia and their primary family or friend caregivers from five matched sites (two randomly selected treatment sites). Data came from VA records; supplemented by caregiver research interviews. Regression analyses using the likelihood and number of hospital and ED visits as outcomes tested for overall treatment-comparison group differences and statistical interactions with cognitive impairment and behavioral symptoms.
RESULTS
Consistent with the hypothesis, three significant interactions showed treatment-group veterans, with more cognitive impairment and behavioral symptoms, had fewer hospital admissions and ED visits than comparison-group veterans. There were no differences in the likelihood of hospital or ED use.
DISCUSSION
PDC, a low-cost program for veterans and caregivers, was effective in reducing the number, but not the likelihood, of hospital admissions and ED visits. Reductions in service use were greater when caregivers reported more difficulties with veterans' symptoms, which in the absence of PDC would place veterans at risk of being high-volume, high-cost service users.Clinical Trial Registration: ClinicalTrials.gov: NCT00291161.
引言
“痴呆症护理伙伴”（PDC）测试了一项基于退伍军人事务部（VA）医疗中心与阿尔茨海默病协会分会之间合作关系的护理协调项目。该假设认为，PDC将降低退伍军人住院和急诊就诊的可能性及次数，尤其是对于那些认知障碍或行为症状更严重的退伍军人。
方法
样本包括来自五个匹配地点（两个随机选择的治疗地点）的328名患有痴呆症的退伍军人及其主要家庭或朋友护理人员。数据来自VA记录，并辅以护理人员研究访谈。以住院和急诊就诊的可能性及次数为结果进行回归分析，以测试总体治疗组与对照组之间的差异以及与认知障碍和行为症状的统计交互作用。
结果
与假设一致，三项显著的交互作用表明，认知障碍和行为症状更严重的治疗组退伍军人的住院和急诊就诊次数少于对照组退伍军人。在住院或急诊使用的可能性方面没有差异。
讨论
PDC是一项针对退伍军人及其护理人员的低成本项目，在减少住院和急诊就诊次数方面有效，但在降低可能性方面无效。当护理人员报告在处理退伍军人症状方面有更多困难时，服务使用的减少更为显著，而在没有PDC的情况下，这些退伍军人有成为高使用量、高成本服务使用者的风险。临床试验注册：ClinicalTrials.gov：NCT00291161。
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