LUCAS, Center for Care Research and Consultancy, KULeuven, Leuven, Belgium.
Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
BMC Geriatr. 2020 Jun 5;20(1):195. doi: 10.1186/s12877-020-01593-w.
In order to optimize interventions and services in the community, it is important to identify the profile of persons who are able to stay at home and of those who are being admitted into residential care. Understanding their needs and their use of resources is essential. The main objective of the study is to identify persons who are likely to enter residential care based upon their needs and resource utilization, so that care providers can plan interventions effectively and optimize services and resources to meet the persons' needs.
This is a longitudinal quasi-experimental study. The data consists of primary data from the community setting collected every six months during the period of 2010-2016. Interventions had the goal of keeping older people longer at home. Participants were at least 65 years old and were living in the community. The interRAI Resource Utilization Group system (RUG-III) was used to calculate the case-mix indexes (CMI) of all participants. Comparisons were made between the case-mix of those who were still living at home and those who were admitted into residential care at follow-up.
A total of 10,289 older persons participated in the study (81.2 ± 7.1 yrs., 69.1% female). From this population, 853 participants (8.3%) were admitted into residential care. The CMI of the persons receiving night care at home were the highest (1.6 at baseline and 1.7 at the entry point of residential care), followed by persons receiving occupational therapy (1.5 at baseline and 1.6 at the entry point of residential care) and persons enrolled in case management interventions with rehabilitation (1.4 at baseline and 1.6 at the entry point of residential care). The CMIs at follow-up were significantly higher than at baseline and the linear regression model showed that admission to residential care was a significant factor in the model.
The study showed that the RUG-III system offers possibilities for identifying persons at risk of institutionalization. Interventions designed to avoid early nursing home admission can make use of the RUG-III system to optimize care planning and the allocation of services and resources. Based on the RUG-III case-mix, resources can be allocated to keep older persons at home longer, bearing in mind the complexity of care and the availability of services in the community.
为了优化社区干预措施和服务，确定能够居家和入住养老院的人员的特征非常重要。了解他们的需求和资源利用情况至关重要。本研究的主要目的是根据他们的需求和资源利用情况确定可能进入养老院的人员，以便护理人员能够有效地进行干预，并优化服务和资源以满足人员的需求。
这是一项纵向准实验研究。数据来自 2010 年至 2016 年期间社区环境中每六个月收集的原始数据。干预措施旨在使老年人在家中停留更长时间。参与者年龄至少 65 岁，居住在社区中。使用 interRAI 资源利用组系统（RUG-III）计算所有参与者的病例组合指数（CMI）。将仍在家中居住的参与者与随访时入住养老院的参与者的病例组合进行比较。
共有 10289 名老年人参与了研究（81.2±7.1 岁，69.1%为女性）。在这一人群中，有 853 名参与者（8.3%）入住养老院。在家中接受夜间护理的人员的 CMI 最高（基线时为 1.6，入住养老院时为 1.7），其次是接受职业治疗的人员（基线时为 1.5，入住养老院时为 1.6）和接受康复案例管理干预的人员（基线时为 1.4，入住养老院时为 1.6）。随访时的 CMI 明显高于基线时，线性回归模型显示入住养老院是该模型中的一个显著因素。
该研究表明，RUG-III 系统提供了识别有机构化风险的人员的可能性。旨在避免早期入住养老院的干预措施可以利用 RUG-III 系统来优化护理计划和服务及资源的分配。根据 RUG-III 的病例组合，资源可以分配给那些能够更长时间在家的老年人，同时考虑到社区中护理的复杂性和服务的可用性。
