社区脑卒中患者照护协调：一项复杂干预研究的结果。
Community care coordination for stroke survivors: results of a complex intervention study.
机构信息
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
出版信息
BMC Health Serv Res. 2020 Dec 19;20(1):1143. doi: 10.1186/s12913-020-05993-x.
BACKGROUND
Outpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multifaceted and heterogeneous health care needs. The objective of this complex intervention study was to evaluate the effectiveness of a post-stroke care coordination program in comparison to standard care in the first year after a stroke.
METHODS
Patients aged 55 and older who had survived a stroke or a transient ischemic attack (TIA) within the last 6 months before enrollment were included. Participants received care coordination either by telephone or face-to-face for up to 1 year. Patients' health insurance claims data were used to measure outcomes. The control group consisted of stroke survivors receiving standard care and was constructed by exact matching based on six criteria. Outcome measures were health services utilization, rate of recurrent events, readmissions and accompanying costs, and mortality. Outcomes were tested using different multiple models.
RESULTS
In total, N = 361 patients were included in the analyses. Intervention participants had seen an outpatient neurologist more often (OR = 4.75; 95% CI: 2.71-8.31) and were readmitted to a hospital less frequently (IRR = 0.42; 95% CI: 0.29-0.61), resulting in lower hospital costs (IQR = €0-1910 in the intervention group, IQR = €0-4375 in the control group). There were no substantial group differences in the rate of recurrent events and mortality.
CONCLUSION
This study showed the beneficial potential of care coordination for a vulnerable patient population: the utilization rate of important health services was increased, and the rate of hospital readmissions decreased as a result. Future research should focus on the risk of recurrent strokes and the long-term effects of improved care.
TRIAL REGISTRATION
DRKS00017526 on DRKS - German Clinical Trials Register (retrospectively registered: 21 June 2019).
背景
门诊随访护理对于脑卒中幸存者来说往往不够充分，且主要由患者自行组织。在德国的医疗保健系统中，患者出院后没有标准的护理计划来满足他们多方面和异质的医疗保健需求。本项复杂干预研究的目的是评估卒中后护理协调方案与标准护理相比在卒中后 1 年内的有效性。
方法
本研究纳入年龄在 55 岁及以上、在入组前 6 个月内经历过脑卒中或短暂性脑缺血发作（TIA）的幸存者。参与者接受了为期长达 1 年的电话或面对面的护理协调。使用患者的健康保险索赔数据来测量结果。对照组由接受标准护理的卒中幸存者组成，并根据六个标准进行精确匹配。结果测量包括卫生服务利用、复发事件、再入院和伴随费用以及死亡率。使用不同的多元模型来检验结果。
结果
共有 361 名患者纳入分析。干预组患者更频繁地看门诊神经科医生（OR=4.75；95%CI：2.71-8.31），较少再住院（IRR=0.42；95%CI：0.29-0.61），导致住院费用降低（干预组 IQR=0-1910 欧元，对照组 IQR=0-4375 欧元）。在复发事件和死亡率方面，两组间无实质性差异。
结论
本研究表明，护理协调对弱势患者群体具有潜在益处：重要卫生服务的利用率增加，再入院率降低。未来的研究应关注复发性中风的风险和护理改善的长期效果。
试验注册
DRKS00017526 号在 DRKS-德国临床试验注册处（回顾性注册：2019 年 6 月 21 日）。
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