Reyes Bernardo, Diaz Sanya, Engstrom Gabriella, Ouslander Joseph
Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA.
J Am Geriatr Soc. 2021 Jun;69(6):1638-1645. doi: 10.1111/jgs.17137. Epub 2021 Mar 26.
BACKGROUND/OBJECTIVES: Evidence on the effectiveness of inpatient hospital geriatric consultation is scant, and it is unknown whether adherence to specific recommendations will improve care and patient outcomes. This study was conducted to provide insights from a quality improvement project that may help guide further improvements in the effectiveness of these consultations made as a component of a care transitions program (CTP).
Secondary analysis of the implementation of a multicomponent CTP for high-risk hospitalized patients aged 75 and older.
A 400-bed community teaching hospital.
Two hundred and two patients admitted to non-ICU beds who met high-risk criteria.
Inpatient comprehensive geriatric consultation including care transition recommendations, telephone and in-person follow-up weekly for 4 weeks after discharge, and collaboration with post-acute organizations and primary care and specialist physicians to implement recommendations.
Primary outcomes for this analysis was 30-day hospital readmissions and adherence to transition of care recommendations.
The 142 patients with at least one post-discharge visit received 936 care transition recommendations. Overall, 663 (71%) of the 936 care transition recommendations were adhered to (71%). The adherence rate was lower in the 22 patients who were readmitted to the hospital within 30 days (63%) compared to 72% adherence in the 120 patients who were not readmitted. This was not a statistically significant difference, and there were no significant differences in the number and percent adherence in any recommendation category between the two groups.
We found adherence to just over two-thirds of care transition recommendations, similar to a small number of other studies. We did not find a relationship between the number of recommendations and adherence to them with 30-day readmissions to the hospital. Future studies of CTPs should consider several strategies may enhance geriatric consultation care transitions recommendations and adherence to them, and improve patient outcomes.
背景/目的：关于住院老年医学会诊有效性的证据很少，而且尚不清楚遵循特定建议是否会改善护理和患者结局。本研究旨在提供一项质量改进项目的见解，该项目可能有助于指导作为护理过渡计划（CTP）一部分进行的这些会诊有效性的进一步提高。
对针对75岁及以上高危住院患者实施的多组分CTP进行二次分析。
一家拥有400张床位的社区教学医院。
202名入住非重症监护病房且符合高危标准的患者。
住院综合老年医学会诊，包括护理过渡建议、出院后4周每周进行电话和面对面随访，以及与急性后期组织、初级保健医生和专科医生合作实施建议。
本次分析的主要结局是30天内再次住院以及对护理过渡建议的遵循情况。
142名至少接受过一次出院后随访的患者共收到936条护理过渡建议。总体而言，936条护理过渡建议中有663条（71%）得到了遵循。与未再次住院的120名患者72%的遵循率相比，30天内再次住院的22名患者的遵循率较低（63%）。这一差异无统计学意义，两组在任何建议类别中的遵循数量和百分比均无显著差异。
我们发现略超过三分之二的护理过渡建议得到了遵循，这与其他少数研究结果相似。我们未发现建议数量与30天内再次住院并遵循建议之间存在关联。未来关于CTP的研究应考虑多种策略，这些策略可能会增强老年医学会诊护理过渡建议及其遵循情况，并改善患者结局。
