Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
Department of Methodology and Statistics and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
BMC Geriatr. 2018 Nov 16;18(1):285. doi: 10.1186/s12877-018-0971-4.
To improve continuity and coordination of care in geriatric rehabilitation, an integrated care pathway was developed and implemented in The Netherlands. The purpose of this study was to assess the effects of this pathway on patients and informal caregivers.
Two cohorts of patients and their informal caregivers were prospectively recruited before implementation of the pathway (2011-2012) and after implementation of the pathway (2013-2014). Primary outcome measures were dependence in activities of daily living in patients (KATZ-15) and self-rated burden among informal caregivers (SRB-VAS). Secondary outcome measures were the frequency of performing extended daily activities, social participation, psychological well-being, quality of life and discharge location (patients) and quality of life and objective care burden (informal caregivers). Outcomes were measured at baseline, after three and after nine months.
No effect was shown on the KATZ-15 after three and nine months. However, a larger percentage of patients were discharged home in the care pathway cohort (83% vs 58.1% after three months and 88.6% vs 67.4% after nine months; p = 0.004). Furthermore, after three months, patients from the care pathway cohort performed more extended daily activities (p = 0.014) and informal caregivers experienced a lower self-rated burden (p = 0.05). After nine months, these effects disappeared. No differences were found for the other outcome measures.
Due to the positive effects of the integrated care pathway, we are inclined to recommend implementing the care pathway in regular care. To have longer lasting effects among patients and informal caregivers, we suggest actively disseminating information about the pathway to primary care providers who are currently still unaware of its content.
ISRCTN90000867 (date of registration: 07-04-2016).
为了提高老年康复护理的连续性和协调性，荷兰开发并实施了一种综合护理路径。本研究旨在评估该路径对患者和非正式照护者的影响。
在实施路径之前（2011-2012 年）和实施路径之后（2013-2014 年），前瞻性招募了两组患者及其非正式照护者。主要结局指标为患者日常生活活动能力依赖程度（KATZ-15）和非正式照护者自评负担（SRB-VAS）。次要结局指标为进行扩展日常活动、社会参与、心理幸福感、生活质量和出院地点（患者）以及生活质量和客观护理负担（非正式照护者）的频率。在基线、三个月和九个月时测量结果。
三个月和九个月时，KATZ-15 没有显示出效果。然而，在护理路径组中，更多的患者出院回家（三个月后分别为 83%和 58.1%，九个月后分别为 88.6%和 67.4%；p=0.004）。此外，三个月后，护理路径组的患者进行了更多的扩展日常活动（p=0.014），非正式照护者的自评负担较低（p=0.05）。九个月后，这些影响消失。其他结果指标无差异。
由于综合护理路径的积极影响，我们倾向于推荐在常规护理中实施该路径。为了使患者和非正式照护者的效果更持久，我们建议积极向目前仍不了解该路径内容的初级保健提供者传播该路径的信息。
ISRCTN90000867（注册日期：2016 年 4 月 7 日）。
