Merchant Reshma Aziz, Ho Vanda Wen Teng, Chen Matthew Zhixuan, Wong Beatrix Ling Ling, Lim Zhiying, Chan Yiong Huak, Ling Natalie, Ng Shu Ee, Santosa Amelia, Murphy Diarmuid, Vathsala Anantharaman
Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Front Med (Lausanne). 2022 Jun 6;9:908100. doi: 10.3389/fmed.2022.908100. eCollection 2022.
While hospitalist and internist inpatient care models dominate the landscape in many countries, geriatricians and internists are at the frontlines managing hospitalized older adults in countries such as Singapore and the United Kingdom. The primary aim of this study was to determine outcomes for older patients cared for by geriatricians compared with non-geriatrician-led care teams.
A retrospective cohort study of 1,486 Internal Medicine patients aged ≥75 years admitted between April and September 2021 was conducted. They were either under geriatrician or non-geriatrician (internists or specialty physicians) care. Data on demographics, primary diagnosis, comorbidities, mortality, readmission rate, Hospital Frailty Risk Score (HFRS), Age-adjusted Charlson Comorbidity Index, Length of Stay (LOS), and cost of hospital stay were obtained from the hospital database and analyzed.
The mean age of patients was 84.0 ± 6.3 years, 860 (57.9%) females, 1,183 (79.6%) of Chinese ethnicity, and 902 (60.7%) under the care of geriatricians. Patients under geriatrician were significantly older and had a higher prevalence of frailty, dementia, and stroke, whereas patients under non-geriatrician had a higher prevalence of diabetes and hypertension. Delirium as the primary diagnosis was significantly higher among patients under geriatrician care. Geriatrician-led care model was associated with shorter LOS, lower cost, similar inpatient mortality, and 30-day readmission rates. LOS and cost were lower for patients under geriatrician care regardless of frailty status but significant only for low and intermediate frailty groups. Geriatrician-led care was associated with significantly lower extended hospital stay (OR 0.73; 95% CI 0.56-0.95) and extended cost (OR 0.69; 95% CI 0.54-0.95).
Geriatrician-led care model showed shorter LOS, lower cost, and was associated with lower odds of extended LOS and cost.
虽然在许多国家，住院医师和内科医生的住院护理模式占据主导地位，但在新加坡和英国等国家，老年病医生和内科医生处于管理住院老年患者的前沿。本研究的主要目的是确定由老年病医生护理的老年患者与非老年病医生主导的护理团队相比的治疗结果。
对2021年4月至9月期间收治的1486名年龄≥75岁的内科患者进行了一项回顾性队列研究。他们接受老年病医生或非老年病医生（内科医生或专科医生）的护理。从医院数据库中获取并分析了有关人口统计学、主要诊断、合并症、死亡率、再入院率、医院衰弱风险评分（HFRS）、年龄调整后的查尔森合并症指数、住院时间（LOS）和住院费用的数据。
患者的平均年龄为84.0±6.3岁，女性860名（57.9%），华裔1183名（79.6%），902名（60.7%）接受老年病医生的护理。接受老年病医生护理的患者年龄明显更大，衰弱、痴呆和中风的患病率更高，而接受非老年病医生护理的患者糖尿病和高血压的患病率更高。以谵妄作为主要诊断的患者在老年病医生护理组中明显更高。老年病医生主导的护理模式与较短的住院时间、较低的费用、相似的住院死亡率和30天再入院率相关。无论衰弱状态如何，接受老年病医生护理的患者住院时间和费用都较低，但仅对低和中度衰弱组有显著意义。老年病医生主导的护理与显著更低的延长住院时间（比值比0.73；95%置信区间0.56 - 0.95）和延长费用（比值比0.69；95%置信区间0.54 - 0.95）相关。
老年病医生主导的护理模式显示住院时间更短、费用更低，并且与延长住院时间和费用的较低几率相关。
