Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre and the National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5011, Australia.
Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI) Adelaide 5001, Australia.
Age Ageing. 2021 Jun 28;50(4):1243-1251. doi: 10.1093/ageing/afaa272.
The purpose of this paper is to investigate the utilisation of general practice Medicare Benefit Schedule (MBS) services aligned to Comprehensive Geriatric Assessment (CGA) within 6 months of an aged care eligibility assessment and its effects on mortality and transition to permanent residential aged care (PRAC).
Retrospective cohort study from the Historical Cohort of the Registry of Senior Australians.
Community.
In total, 69,171 Individuals (aged 75+) receiving home care packages (HCPs) between 2011 and 2015.
Mortality and transition to PRAC.
The claims for a management plan with team care arrangement (TCA) within 3 months of the health assessment (i.e. CGA) was present in 5% and associated with 14% lower mortality (adjusted hazard ratio [aHR], 95%CI = 0.86, 0.80-0.93) compared to no claims, lower than that seen with partial CGA which was either health assessment claims only 7.0% (aHR, 95%CI = 0.93, 0.89-0.97) or management plan coupled with TCA claims only 9.0% (aHR, 95%CI = 0.91, 0.89-0.97). This pattern was seen in those frailer but not in those where the frailty index score was <0.21. Claims for management plans coupled with TCAs alone were associated with a 10% lower transition to PRAC (asHR, 95%CI = 0.90, 0.85-0.96) in those with FI score < 0.21 while this estimate was not significant in individuals with FI score ≥ 0.21.
It appears the conduct of a combination of interventions considered to be components of the CGA by GPs was associated with a lower risk of mortality that no claims or partial conduct of CGA.
本文旨在调查在老年护理资格评估后 6 个月内，根据综合老年评估（CGA）使用一般实践医疗保险福利计划（MBS）服务的情况，及其对死亡率和向永久性居住养老院（PRAC）过渡的影响。
澳大利亚老年人登记册历史队列的回顾性队列研究。
社区。
共有 69171 名在 2011 年至 2015 年间接受家庭护理包（HCP）的年龄在 75 岁以上的个体。
死亡率和向 PRAC 过渡。
在健康评估（即 CGA）后 3 个月内提出管理计划并附有团队护理安排（TCA）的索赔占 5%，与无索赔相比，死亡率降低了 14%（调整后的危险比[HR]，95%CI=0.86，0.80-0.93），低于部分 CGA 所报告的死亡率，部分 CGA 仅提出健康评估索赔占 7.0%（HR，95%CI=0.93，0.89-0.97）或仅提出管理计划和 TCA 索赔占 9.0%（HR，95%CI=0.91，0.89-0.97）。这种模式在那些更脆弱的个体中可见，但在脆弱指数评分<0.21 的个体中不可见。对于脆弱指数评分<0.21 的个体，仅提出管理计划和 TCA 索赔与向 PRAC 的过渡风险降低 10%相关（asHR，95%CI=0.90，0.85-0.96），而对于脆弱指数评分≥0.21 的个体，这一估计并不显著。
似乎由全科医生实施的被认为是 CGA 组成部分的一系列干预措施的结合，与无索赔或部分实施 CGA 相比，与死亡率降低相关。
