技术监测下院内设施中的过渡护理方案可缩短老年患者的住院时间并改善多维脆弱性：一项随机临床试验。
A transitional care program in a technologically monitored in-hospital facility reduces the length of hospital stay and improves multidimensional frailty in older patients: a Randomized Clinical Trial.
机构信息
Department of Geriatric Care, Neurology and Rehabilitation, E.O. Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy.
Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy.
出版信息
Aging Clin Exp Res. 2024 Aug 6;36(1):160. doi: 10.1007/s40520-024-02821-8.
BACKGROUND
Longer length of hospital stay (LOS) negatively affects the organizational efficiency of public health systems and both clinical and functional aspects of older patients. Data on the effects of transitional care programs based on multicomponent interventions to reduce LOS of older patients are scarce and controversial.
AIMS
The PRO-HOME study aimed to assess the efficacy in reducing LOS of a transitional care program involving a multicomponent intervention inside a technologically monitored in-hospital discharge facility.
METHODS
This is a Randomized Clinical Trial on 60 patients (≥65 years), deemed stable and dischargeable from the Acute Geriatrics Unit, equally assigned to the Control Group (CG) or Intervention Group (IG). The latter underwent a multicomponent intervention including lifestyle educational program, cognitive and physical training. At baseline, multidimensional frailty according to the Multidimensional Prognostic Index (MPI), and Health-Related Quality of Life (HRQOL) were assessed in both groups, along with physical capacities for the IG. Enrolled subjects were evaluated after 6 months of follow-up to assess multidimensional frailty, HRQOL, and re-hospitalization, institutionalization, and death rates.
RESULTS
The IG showed a significant 2-day reduction in LOS (median days IG = 2 (2-3) vs. CG = 4 (3-6); p < 0.001) and an improvement in multidimensional frailty at 6 months compared to CG (median score IG = 0.25(0.25-0.36) vs. CG = 0.38(0.31-0.45); p = 0.040). No differences were found between the two groups in HRQOL, and re-hospitalization, institutionalization, and death rates.
DISCUSSION
Multidimensional frailty is a reversible condition that can be improved by reduced LOS.
CONCLUSIONS
The PRO-HOME transitional care program reduces LOS and multidimensional frailty in hospitalized older patients.
TRIAL REGISTRATION
ClinicalTrials.gov n. NCT06227923 (retrospectively registered on 29/01/2024).
背景
住院时间延长（LOS）会对公共卫生系统的组织效率以及老年患者的临床和功能方面产生负面影响。基于多组分干预措施以减少老年患者 LOS 的过渡护理计划的数据稀缺且存在争议。
目的
PRO-HOME 研究旨在评估包含多组分干预措施的过渡护理计划在技术监测的院内出院设施内减少 LOS 的效果。
方法
这是一项针对 60 名（≥65 岁）患者的随机临床试验，这些患者被认为从急性老年科病房稳定并可出院，被平均分配到对照组（CG）或干预组（IG）。后者接受了多组分干预措施，包括生活方式教育计划、认知和身体训练。在基线时，根据多维预后指数（MPI）评估两组的多维脆弱性，以及健康相关生活质量（HRQOL），并对 IG 进行身体能力评估。在 6 个月的随访后，评估入组患者的多维脆弱性、HRQOL、再住院率、住院率和死亡率。
结果
IG 的 LOS 显著减少了 2 天（中位数 IG=2（2-3）天 vs. CG=4（3-6）天；p<0.001），并且与 CG 相比，6 个月时多维脆弱性得到改善（中位数 IG=0.25（0.25-0.36）分 vs. CG=0.38（0.31-0.45）分；p=0.040）。两组在 HRQOL、再住院率、住院率和死亡率方面没有差异。
讨论
多维脆弱性是一种可逆的状态，可以通过缩短 LOS 来改善。
结论
PRO-HOME 过渡护理计划可缩短住院老年患者的 LOS 和多维脆弱性。
试验注册
ClinicalTrials.gov n. NCT06227923（于 2024 年 1 月 29 日回顾性注册）。
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