Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
Section of Health Care Research and Rehabilitation Research (SEVERA), Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
BMC Health Serv Res. 2024 Feb 14;24(1):203. doi: 10.1186/s12913-024-10635-7.
The Coordinated medical Care (CoCare) project aimed to improve the quality of medical care in nursing homes by optimizing collaboration between nurses and physicians. We analyze the impact of the CoCare intervention on overall survival.
The effect of time-varying treatment on 3-year overall survival was analyzed with treatment as time-varying covariate within the entire cohort. To reduce bias due to non-random assignment to treatment groups, regression adjustment was applied. Therefore, age, sex, and level of care were used as potential confounders.
The study population consisted of 8,893 nursing home residents (NHRs), of which 1,330 participated in the CoCare intervention. The three-year overall survival was 49.8% in the entire cohort. NHRs receiving the intervention were associated with a higher survival probability compared to NHRs of the control group. In a univariable cox model with time-dependent treatment, the intervention was associated with a hazard ratio of 0.70 [95%CI 0.56-0.87, p = 0.002]. After adjustment for age, sex and level of care, the hazard ratio increased to 0.82 but was still significant [95%CI 0.71-0.96, p = 0.011].
The analysis shows that optimizing collaboration between nurses and physicians leads to better survival of NHRs in Germany. This adds to the already published favorable cost-benefit ratio of the CoCare intervention and shows that a routine implementation of optimized collaboration between nurses and physicians is highly recommended.
协调医疗护理（CoCare）项目旨在通过优化护士和医生之间的协作来提高养老院的医疗质量。我们分析了 CoCare 干预对总生存率的影响。
通过将治疗作为整个队列中的时变协变量，分析时变治疗对 3 年总生存率的影响。为了减少由于非随机分配到治疗组而导致的偏差，应用了回归调整。因此，年龄、性别和护理水平被用作潜在的混杂因素。
研究人群包括 8893 名养老院居民（NHR），其中 1330 名参与了 CoCare 干预。整个队列的 3 年总生存率为 49.8%。与对照组的 NHR 相比，接受干预的 NHR 具有更高的生存概率。在一个时变治疗的单变量 Cox 模型中，干预与风险比为 0.70 [95%CI 0.56-0.87，p=0.002]相关。在调整年龄、性别和护理水平后，风险比增加到 0.82，但仍具有显著性[95%CI 0.71-0.96，p=0.011]。
分析表明，优化护士和医生之间的协作可提高德国 NHR 的生存率。这增加了 CoCare 干预已经发表的有利的成本效益比，并表明常规实施优化的护士和医生之间的协作是高度推荐的。
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