Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.
Équipe Régionale Vieillissement et Prévention de la Dépendance (ERVPD), Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.
JAMA Netw Open. 2020 Feb 5;3(2):e200049. doi: 10.1001/jamanetworkopen.2020.0049.
Dementia is often underdiagnosed in nursing homes (NHs). This potentially results in inappropriate care, and high rates of emergency department (ED) transfers in particular.
To assess whether systematic dementia screening of NH residents combined with multidisciplinary team meetings resulted in a lower rate of ED transfer at 12 months compared with usual care.
DESIGN, SETTING, AND PARTICIPANTS: Multicenter, cluster randomized trial with NHs as the unit of randomization. The IDEM (Impact of Systematic Tracking of Dementia Cases on the Rate of Hospitalization in Emergency Care Units) trial took place at 64 public and private NHs in France. Recruitment started on May 1, 2010, and was completed on March 31, 2012. Residents who were aged 60 years or older, had no diagnosed or documented dementia, were not bedridden, had lived in the NH for at least 1 month at inclusion, and had a life expectancy greater than 12 months were included. The residents were followed up for 18 months. The main study analyses were completed on October 14, 2016.
Two parallel groups were compared: an intervention group consisting of NHs that set up 2 multidisciplinary team meetings to identify residents with dementia and to discuss an appropriate care plan, and a control group consisting of NHs that continued their usual practice. During the inclusion period of 23 months, all residents of participating NHs who met eligibility criteria were included in the study.
The primary end point (ED transfer) was analyzed at 12 months, but the residents included were followed up for 18 months.
A total of 64 NHs participated in the study and enrolled 1428 residents (mean [SD] age, 84.7 [8.1] years; 1019 [71.3%] female): 599 in the intervention group (32 NHs) and 829 in the control group (32 NHs). The final study visit was completed by 1042 residents (73.0%). The main reason for early discontinuation was death (318 residents [22.7%]). The intervention did not reduce the risk of ED transfers during the 12-month follow-up: the proportion of residents transferred at least once to an ED during the 12-month follow-up was 16.2% in the intervention group vs 12.8% in the control group (odds ratio, 1.32; 95% CI, 0.83-2.09; P = .24).
This study failed to demonstrate that systematic screening for dementia in NHs resulted in fewer ED transfers. The findings do not support implementation of multidisciplinary team meetings for systematic dementia screening of all NH residents, beyond the national recommendations for dementia diagnosis, to reduce ED transfers.
ClinicalTrials.gov Identifier: NCT01569997.
养老院（NH）中经常漏诊痴呆症。这可能导致护理不当，特别是急诊部（ED）的转院率很高。
评估对 NH 居民进行系统的痴呆症筛查，与常规护理相比，是否会在 12 个月时降低 ED 转院率。
设计、地点和参与者： 以 NH 为随机单位的多中心、聚类随机试验。IDE（系统跟踪痴呆症病例对急诊护理单元住院率的影响）试验在法国的 64 家公立和私立 NH 进行。招募于 2010 年 5 月 1 日开始，于 2012 年 3 月 31 日完成。符合条件的居民为年龄在 60 岁或以上、无诊断或记录的痴呆症、非卧床、入住 NH 至少 1 个月、预期寿命超过 12 个月的居民。居民随访了 18 个月。主要研究分析于 2016 年 10 月 14 日完成。
比较了两组平行的干预措施：一个干预组由设立了 2 个多学科团队会议的 NH 组成，以识别患有痴呆症的居民，并讨论适当的护理计划；另一个对照组由继续进行常规护理的 NH 组成。在 23 个月的纳入期内，所有符合入选标准的参与 NH 的居民都被纳入研究。
主要终点（ED 转移）在 12 个月时进行分析，但包括的居民随访了 18 个月。
共有 64 家 NH 参与了研究，共纳入 1428 名居民（平均[标准差]年龄，84.7[8.1]岁；1019[71.3%]女性）：干预组 599 名（32 家 NH）和对照组 829 名（32 家 NH）。共有 1042 名居民完成了最后的研究访问（73.0%）。提前退出的主要原因是死亡（318 名居民[22.7%]）。干预措施并没有降低 12 个月随访期间 ED 转院的风险：在 12 个月的随访期间，至少有一次转至 ED 的居民比例在干预组为 16.2%，在对照组为 12.8%（优势比，1.32；95%置信区间，0.83-2.09；P=0.24）。
本研究未能证明 NH 中对痴呆症的系统筛查会导致 ED 转院人数减少。研究结果不支持除国家痴呆症诊断建议外，对所有 NH 居民进行多学科团队会议进行系统的痴呆症筛查，以减少 ED 转院。
ClinicalTrials.gov 标识符：NCT01569997。
