Faculty of Social Sciences, University of Stirling, Stirling, UK.
Australian Catholic University, Canberra, ACT, Australia.
Palliat Med. 2020 May;34(5):571-579. doi: 10.1177/0269216319891077. Epub 2020 Jan 2.
Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home.
To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital.
Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018.
SETTING/PARTICIPANTS: 1700 residents in 12 Australian care homes for older people.
Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: -0.44, -0.01 and = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m).
The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.
养老院的居民经常被转往医院，而不是在养老院得到适当和及时的专科护理。
确定一种在养老院提供专科姑息治疗的护理模式，即专科姑息治疗需求查房，是否可以减少在医院的住院时间。
阶梯式随机对照试验。主要结局是在急性护理（超过 24 小时）中的住院时间，次要结局是住院的次数和费用。养老院使用随机数发生器随机分配交叉到对照到干预组；由于干预的性质，无法进行盲法。分析采用意向治疗。该试验在澳大利亚临床试验注册中心注册：ACTRN12617000080325。数据收集于 2017 年 2 月 1 日至 2018 年 6 月 30 日之间。
地点/参与者：澳大利亚 12 家老年人养老院的 1700 名居民。
专科姑息治疗需求查房导致住院时间缩短（未调整差异：0.5 天；调整差异：0.22 天，95%置信区间：-0.44，-0.01， = 0.038）。该干预还使每设施月的住院次数减少了 23%，从 5.6 次减少到 4.3 次，具有临床意义。从减少入院人数中估计的每年净节省成本为 1759011 澳元（1300 万美元；980 万英镑）。
该护理模式通过专科姑息治疗临床医生的外展服务显著减少了住院治疗。这些数据为专科姑息治疗需求查房在减少接近生命末期、居住在养老院的老年人的住院治疗提供了有力证据。
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