Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
J Am Med Dir Assoc. 2019 Oct;20(10):1294-1299.e1. doi: 10.1016/j.jamda.2019.03.012. Epub 2019 May 8.
Underpinning standards for delivering comprehensive care in hospital is the need to identify issues contributing to patient complexity and risk of harm. The study aimed to investigate the prevalence of functional and psychosocial problems in hospitalized adults, to compare prevalence rates across age groups, and to assess their impact on discharge outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted in 4 hospitals in Australia during September 2015 to June 2016, recruiting patients aged 18 and over.
Research nurses assessed patients at admission using the interRAI Acute Care instrument, which includes algorithms for diagnostic and risk screening and measuring problem severity. Length of stay and discharge outcome were recorded from medical records.
The median age of the study population (n = 910) was 66 (range 18-99 years), and 47.7% were female. Although 64.6% of patients aged ≥70 years had at least 1 classic geriatric syndrome (cognitive impairment, dependency in activities of daily living, history of falls, or incontinence), similar problems were prevalent in younger cohorts (34.6% in those aged <50 and 38.9% in those aged 50-69 years). Of 17 health issues assessed across multiple domains, only 26 patients (2.9%) had no problems. Independent of age, gender, and Comorbidity Index, having a greater number of problems was significantly associated with an adverse discharge outcome, odds ratio 1.19 (95% confidence interval (CI) 1.09-1.29); for each additional problem, the length of stay increased by 6.7% (95% CI 4.3%-9.2%).
CONCLUSIONS/IMPLICATIONS: The high prevalence of functional and psychosocial problems across the age range of patients indicates that universal screening and assessment is warranted for all adult patients to aid in care planning to meet patient needs both in acute care and post discharge.
为了确定导致患者病情复杂和受伤风险的问题，为医院提供全面护理的标准提供了依据。本研究旨在调查住院成年人的功能和心理社会问题的患病率，比较不同年龄组的患病率，并评估其对出院结果的影响。
设计、地点和参与者：2015 年 9 月至 2016 年 6 月，在澳大利亚的 4 家医院进行了一项前瞻性队列研究，招募了年龄在 18 岁及以上的患者。
研究护士在入院时使用 interRAI 急性护理工具评估患者，该工具包括诊断和风险筛查算法以及衡量问题严重程度。从病历中记录住院时间和出院结果。
研究人群（n=910）的中位年龄为 66 岁（范围 18-99 岁），47.7%为女性。尽管≥70 岁的患者中有 64.6%至少有一种经典老年综合征（认知障碍、日常生活活动依赖、跌倒史或失禁），但年轻患者中也存在类似的问题（<50 岁的患者中有 34.6%，50-69 岁的患者中有 38.9%）。在多个领域评估的 17 项健康问题中，只有 26 名患者（2.9%）没有问题。无论年龄、性别和合并症指数如何，存在更多问题与不良出院结果显著相关，优势比 1.19（95%置信区间（CI）1.09-1.29）；每增加一个问题，住院时间增加 6.7%（95%CI 4.3%-9.2%）。
结论/意义：患者年龄范围内功能和心理社会问题的高患病率表明，所有成年患者都需要进行普遍筛查和评估，以帮助制定护理计划，满足患者在急性护理和出院后的需求。
