中国佛山农村地区衰弱老年人社区为基础的综合关怀模式（CIE）评价：一项阶梯式整群随机对照试验研究方案{1}。

Evaluation of a community-based integrated care model (CIE) for frail older people in rural Foshan, China: study protocol for a stepped-wedge cluster randomized controlled trial {1}.

机构信息

Department of General Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.

出版信息

Trials. 2023 May 8;24(1):315. doi: 10.1186/s13063-023-07328-7.

DOI:10.1186/s13063-023-07328-7

PMID:37158975

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10165829/

Abstract

BACKGROUND

While community-based eldercare has proven to be effective in qualitative studies, there is limited evidence on the effectiveness of this geriatric care model in rural communities where caring for older people is traditionally the responsibility of family members, but a formal long-term care was recently introduced in China. CIE is a rural community-embedded intervention using multidisciplinary team, to provide evidenced-based integrated care services for frail older people including social care services and allied primary healthcare and community-based rehabilitation services.

METHODS

CIE is a prospective stepped-wedge cluster randomized trial conducted at 5 community eldercare centers in rural China. The multifaceted CIE intervention, guided by chronic care model and integrated care model, consists of five components: comprehensive geriatric assessment, individualized care planning, community-based rehabilitation, interdisciplinary case management, and care coordination. The intervention is rolled out in a staggered manner in these clusters of centers at an interval of 1 month. The primary outcomes include functional status, quality of life, and social support. Process evaluation will also be conducted. Generalized linear mixed model is employed for binary outcomes.

DISCUSSION

This study is expected to provide important new evidence on clinical effectiveness and implementation process of an integrated care model for frail older people. The CIE model is also unique as the first registered trial implementing a community-based eldercare model using multidisciplinary team to promote individualized social care services integrated with primary healthcare and community-based rehabilitation services for frail older people in rural China, where formal long-term care was recently introduced. TRIAL REGISTRATION {2A}: China Clinical Trials Register ( http://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2200060326 ). May 28th, 2022.

摘要

背景

虽然基于社区的老年护理在定性研究中已被证明是有效的，但在传统上由家庭成员负责照顾老年人的农村社区中，这种老年护理模式的有效性证据有限，而在中国最近引入了正式的长期护理。CIE 是一种农村社区嵌入式干预措施，使用多学科团队，为体弱老年人提供基于证据的综合护理服务，包括社会护理服务以及初级医疗保健和社区康复服务。

方法

CIE 是在中国农村的 5 个社区老年护理中心进行的前瞻性分步楔形集群随机试验。多方面的 CIE 干预措施以慢性病护理模式和综合护理模式为指导，包括五个部分：全面老年评估、个性化护理计划、社区康复、跨学科病例管理和护理协调。该干预措施以交错的方式在这些中心的集群中以 1 个月的间隔推出。主要结果包括功能状态、生活质量和社会支持。还将进行过程评估。使用广义线性混合模型分析二分类结果。

讨论

这项研究有望为体弱老年人综合护理模式的临床效果和实施过程提供重要的新证据。CIE 模型也很独特，因为它是第一个使用多学科团队实施基于社区的老年护理模式的注册试验，旨在为中国农村地区的体弱老年人推广个性化社会护理服务，这些地区最近引入了正式的长期护理。试验注册{2A}：中国临床试验注册中心（http://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2200060326）。2022 年 5 月 28 日。