Schapira Marcelo, Outumuro María Belén, Giber Fabiana, Pino Claudia, Mattiussi Mercedes, Montero-Odasso Manuel, Boietti Bruno, Saimovici Javier, Gallo Cristian, Hornstein Lucila, Pollán Javier, Garfi Leonardo, Osman Abdelhady, Perman Gastón
Internal Medicine Service, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina.
Geriatric Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
Aging Clin Exp Res. 2022 Jan;34(1):85-93. doi: 10.1007/s40520-021-01893-0. Epub 2021 Jun 7.
Hospitalization is a moment of extreme vulnerability for frail older adults. There is scarce evidence on the effectiveness of geriatric co-management or transitional care interventions in Latin America.
To assess whether geriatric co-management combined with an interdisciplinary transitional care intervention could reduce 30-day hospital readmission rate compared to usual care in hospitalized frail older patients in a tertiary hospital in Argentina.
Single-blinded randomized controlled trial. Usual care treatment arm: all procedures performed during hospitalization were overseen by a senior internal medicine specialist and complied with pre-defined protocols. Patients had access to specialist care if needed, as well as hospital-at-home or home-based primary care services after discharge. Intervention treatment arm: in addition to usual care, a geriatric co-management team performed a comprehensive geriatric assessment during hospitalization, provided tailored recommendations to minimize geriatric syndromes and planned transition of care. A health and social care counselor oversaw continuity of care in patients' homes after discharge.
We included 120 participants in each of the intervention and usual care (control) arms. Thirty-day hospital readmissions were 47.7% lower in the intervention arm (18.3% vs 35.0%; P = 0.040); and emergency room visits within the first 6 months after discharge were 27.8% lower (43.3% vs 60.0%; P = 0.010). There was a non-statistically significant decrease in 6-month mortality in the intervention arm (25.0% vs 35.0%; P = 0.124).
Geriatric co-management of frail older patients during hospitalization combined with an interdisciplinary transitional care intervention reduced 30-day hospital readmissions and emergency visits 6 months after discharge.
Trial registration number: RENIS IS003081.
住院对于体弱的老年人来说是一个极其脆弱的时期。在拉丁美洲，关于老年病联合管理或过渡性护理干预措施有效性的证据很少。
评估在阿根廷一家三级医院中，与常规护理相比，老年病联合管理结合跨学科过渡性护理干预措施能否降低体弱老年住院患者30天内的再入院率。
单盲随机对照试验。常规护理治疗组：住院期间进行的所有程序均由内科资深专家监督，并符合预先定义的方案。患者在需要时可获得专科护理，出院后还可获得医院到家或居家初级护理服务。干预治疗组：除常规护理外，老年病联合管理团队在住院期间进行全面的老年病评估，提供针对性建议以尽量减少老年综合征，并规划护理过渡。一名健康和社会护理顾问在患者出院后监督其居家护理的连续性。
干预组和常规护理（对照组）各纳入120名参与者。干预组30天内的再入院率低47.7%（18.3%对35.0%；P = 0.040）；出院后头6个月内的急诊就诊率低27.8%（43.3%对60.0%；P = 0.010）。干预组6个月死亡率有非统计学意义的下降（25.0%对35.0%；P = 0.124）。
住院期间对体弱老年患者进行老年病联合管理并结合跨学科过渡性护理干预措施，可降低30天内的再入院率以及出院后6个月内的急诊就诊率。
试验注册号：RENIS IS003081
