移动综合健康计划可安全有效地管理老年人未分化的急性疾病。
A mobile integrated health program for the management of undifferentiated acute complaints in older adults is safe and feasible.
机构信息
Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
出版信息
Acad Emerg Med. 2023 Nov;30(11):1110-1116. doi: 10.1111/acem.14791. Epub 2023 Aug 31.
BACKGROUND
Poor care access and lack of proper triage of medical complaints leads to inappropriate use of acute care resources. Mobile integrated health (MIH) programs may offer a solution by providing adaptable on-demand care. There is little information describing programs that manage undifferentiated complaints in the community. The objective of this study was to assess the safety and feasibility of an MIH program that responds to the community to manage medical complaints in older adults.
METHODS
This was a prospective observational study examining a pilot MIH program. Seven ambulatory clinics and their affiliated patients aged 65 and older were oriented to the program and invited to use its services. Visit and follow-up data for all patients who underwent an MIH visit were abstracted, along with 30-day follow-up information. All demographic data and outcomes were reported descriptively.
RESULTS
In 21 months, 153 MIH visits were completed, involving 91 patients (mean age 81 years, 60.4% female). The most common chief complaints were generalized weakness (28.8%) and shortness of breath (18.9%). Electrocardiogram (57.5%) and point-of-care bloodwork (34.6%) were the most common diagnostic tests performed. Sixteen visits (10.4%) were followed by an emergency department (ED) visit within 72 h. In 11 encounters, the patient was referred to the ED; in five cases, the ED visit was unforeseen. Fifteen patients (9.8%) were admitted to the hospital after an MIH visit. There were two deaths within 30 days following an index visit.
CONCLUSIONS
An MIH program designed to address the acute complaints of community-dwelling older adults was feasible and safe, with low rates of unforeseen emergency services utilizations. MIH programs have valuable diagnostic and therapeutic capabilities and may serve to help triage the acute medical needs of patients. Further study is required to validate the efficacy and cost-effectiveness of MIH programs.
背景
医疗诉求的就诊机会不足和分诊不当，导致了急性护理资源的不当使用。移动综合医疗（MIH）项目通过提供灵活的按需护理，可能提供了一种解决方案。目前，几乎没有信息描述管理社区中未分化投诉的项目。本研究的目的是评估针对社区管理老年患者医疗投诉的 MIH 计划的安全性和可行性。
方法
这是一项前瞻性观察性研究，研究了一个试点 MIH 计划。7 个门诊诊所及其附属的 65 岁及以上患者接受了该计划的培训，并邀请他们使用其服务。对所有接受 MIH 就诊的患者的就诊和随访数据进行了提取，并随访了 30 天。所有人口统计学数据和结果均以描述性方式报告。
结果
在 21 个月的时间里，完成了 153 次 MIH 就诊，涉及 91 名患者（平均年龄 81 岁，60.4%为女性）。最常见的主要投诉是全身乏力（28.8%）和呼吸急促（18.9%）。最常进行的诊断测试是心电图（57.5%）和床边血液检查（34.6%）。16 次就诊（10.4%）在 72 小时内随后前往急诊部（ED）就诊。在 11 次就诊中，患者被转至 ED；在 5 例中，ED 就诊是意料之外的。15 名患者（9.8%）在 MIH 就诊后被收治入院。在指数就诊后 30 天内有 2 人死亡。
结论
设计用于解决社区居住的老年患者急性诉求的 MIH 计划是可行且安全的，意外使用急诊服务的比例较低。MIH 计划具有有价值的诊断和治疗能力，可用于帮助分诊患者的急性医疗需求。需要进一步的研究来验证 MIH 计划的疗效和成本效益。
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