Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, South Korea.
Institute of Aging, Seoul National University, South Korea.
Gerontologist. 2021 Apr 3;61(3):460-469. doi: 10.1093/geront/gnaa090.
The objective of this study was to evaluate the impact of an information and communication technologies (ICT)-enhanced, multidisciplinary integrated care model, called Systems for Person-centered Elder Care (SPEC), on frail older adults at nursing homes.
SPEC was implemented at 10 nursing homes in South Korea in random order using a stepped-wedge design. Data were collected on all participating older residents in the homes before the first implementation and until 6 months after the last implementation. The 21-month SPEC intervention guided by the chronic care model (CCM) consists of 5 strategies: comprehensive geriatric assessment, care planning, optional interdisciplinary case conferences, care coordination, and a cloud-based ICT tool along with a free messaging app. The primary outcome was quality of care measured by a composite quality indicator (QI) from the interRAI assessment system. Usual care continued over the control periods. Nursing home staff were not blinded to the intervention.
There were a total of 482 older nursing home residents included in the analysis. Overall quality of care measured by the composite QI was significantly improved (adjusted mean difference: -0.025 [95% CI: -0.037 to -0.014, p < .0001]). The intervention effect was consistent in the subgroup analysis by cognition and activities of daily living. There were no important adverse events or side effects.
The SPEC, a CCM-guided, ICT-supported, multidisciplinary integrated care management intervention, can improve the quality of care measured by health and functional outcomes for frail older persons residing in nursing homes with limited health care provision.
ISRCTN11972147.
本研究旨在评估一种名为 Systems for Person-centered Elder Care（SPEC）的基于信息和通信技术（ICT）的多学科综合护理模式对疗养院体弱老年人的影响。
SPEC 采用阶梯式楔形设计，在韩国的 10 家疗养院随机实施。在第一次实施之前和最后一次实施后的 6 个月内，对所有参与家庭的老年居民进行了数据收集。该 21 个月的 SPEC 干预措施以慢性病护理模式（CCM）为指导，包括 5 项策略：全面老年评估、护理计划、可选的跨学科病例会议、护理协调以及基于云的 ICT 工具和免费消息应用程序。主要结局是通过 interRAI 评估系统的综合质量指标（QI）衡量的护理质量。在对照期间，常规护理继续进行。疗养院工作人员对干预措施并不知情。
共有 482 名老年疗养院居民纳入分析。通过综合 QI 衡量的整体护理质量显著提高（调整平均差异：-0.025 [95%CI：-0.037 至-0.014，p<0.0001]）。在认知和日常生活活动的亚组分析中，干预效果一致。没有发生重要的不良事件或副作用。
SPEC 是一种 CCM 指导、ICT 支持、多学科综合护理管理干预措施，可以提高护理质量，衡量健康和功能结果，为提供有限医疗服务的疗养院体弱老年人提供服务。
ISRCTN82223405。
