Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
BMC Med. 2024 May 29;22(1):212. doi: 10.1186/s12916-024-03427-7.
To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients.
We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention.
We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37-4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41-8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24-3.16, p = 0.0042), and number of PIMs use (ꞵ = - 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20-1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75-2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups.
The information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization.
Clinical Research Information Service, KCT0004360. Registered on 21 October 2019.
为了评估针对机构化老年患者的数据共享和综合管理平台的有效性和安全性。
我们采用信息技术支持的综合卫生服务平台，对长期护理医院（LTCH）和养老院（NH）的患者进行了群组随机对照研究。我们纳入了 555 名年龄在 65 岁或以上的患者（461 名来自 7 家 LTCH，94 名来自 5 家 NH）。对于干预组，为医生或护士提供了基于平板电脑的平台，其中包括全面老年评估、疾病管理、潜在不适当药物（PIM）管理、康复计划以及对不良事件和警告警报的筛查。对照组采用常规护理。主要结局指标为：（1）高血压和糖尿病的控制率，（2）药物调整（PIM 处方率、多药使用比例），（3）来自 interRAI 评估系统的潜在医疗质量问题的组合（综合质量指标），干预后 3 个月进行评估。
我们筛选了 1119 名患者，纳入了 555 名患者（对照组 289 名，干预组 266 名）进行分析。与对照组相比，分配到干预组的患者认知功能更好，基线时用药和 PIM 更少。糖尿病控制率（OR=2.61，95%CI 1.37-4.99，p=0.0035）、PIM 停药（OR=4.65，95%CI 2.41-8.97，p<0.0001）、多药使用患者的药物减少（OR=1.98，95%CI 1.24-3.16，p=0.0042）和 PIM 使用数量（ꞵ=-0.27，p<0.0001）显著改善。高血压控制率（OR=0.54，95%CI 0.20-1.43，p=0.2129）、多药使用比例（OR=1.40，95%CI 0.75-2.60，p=0.2863）和综合质量指标的改善（ꞵ=0.03，p=0.2094）无显著差异。次要结局方面，两组间认知和运动功能、生活质量和非计划性住院治疗无显著差异。
信息技术支持的综合卫生服务可有效减少 LTCH 或 NH 老年患者的 PIM 使用，并控制糖尿病，而不会导致功能下降或增加医疗保健利用。
临床研究信息服务，KCT0004360。于 2019 年 10 月 21 日注册。
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