Murray Jenni, Baird Kalpita, Brealey Stephen, Mandefield Laura, Richardson Gerry, O'Hara Jane, Foy Robbie, Sheard Laura, Cracknell Alison, Palacios Alfredo, Walker Simon, Breckin Ed, Mirza Lubena, Baxter Ruth, Hewitt Catherine, Lawton Rebecca
Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary Duckworth Lane, Bradford BD9 6RJ, UK.
York Trials Unit, University of York Department of Health Sciences, York, UK.
Age Ageing. 2025 May 3;54(5). doi: 10.1093/ageing/afaf142.
Transitions from hospital to home are risky for older people. The role of patient involvement in supporting safe transitions is unclear.
To assess the clinical effectiveness of an intervention to improve the safety and experience of care transitions for older people.
Cluster randomised controlled trial.
Eleven National Health Service acute hospital trusts and 42 wards (clusters) routinely providing care for older people (aged 75 years and older) planning to transition back home.
Patient involvement ward-level intervention-Your Care Needs You (YCNY).
Unplanned hospital readmission rates within 30 days of discharge (primary outcome). Secondary outcomes included readmissions at 60 and 90 days post-discharge, experience of transitions and safety events.
Ward as the unit of randomisation from varying medical specialities randomised to YCNY or care-as-usual on a 1:1 basis.
Ward staff, research nurses and researchers were unblinded. Patients were unaware of treatment allocation. Statisticians were blinded to the primary outcome data until statistical analysis plan sign-off.
Using a mixed effects logistic regression we saw no significant difference in unplanned 30-day readmission rates (OR 0.93; 95% CI, 0.78 to 1.10; P = .372) between intervention (17%) and control (19%). At all timepoints, rates were lower in the intervention group. The total number of readmissions was lower in the intervention group (all timepoints) reaching statistical significance across 90-days with 13% fewer readmissions (IRR: 0.87; 95% CI 0.76 to 0.99) than the control. At 30-days only, intervention group patients reported better experiences of transitions and significantly fewer safety events. Serious adverse events were similarly observed in both groups [YCNY: 26 (52.0%), Care-as-usual: 24 (48.0%)]. None related to treatment.
YCNY did not significantly impact on unplanned hospital readmissions at 30 days but in some secondary outcomes we did find evidence of clinical benefit.
从医院过渡到家庭对老年人来说存在风险。患者参与支持安全过渡的作用尚不清楚。
评估一项旨在改善老年人护理过渡安全性和体验的干预措施的临床效果。
整群随机对照试验。
11个国民保健服务急性医院信托机构和42个病房（群组），这些病房常规为计划回家的老年人（75岁及以上）提供护理。
患者参与病房层面的干预措施——“你的护理需要你”（YCNY）。
出院后30天内的非计划住院再入院率（主要结局指标）。次要结局指标包括出院后60天和90天的再入院情况、过渡体验和安全事件。
以病房作为随机化单位，来自不同医学专科的病房按1:1的比例随机分配到YCNY组或常规护理组。
病房工作人员、研究护士和研究人员未设盲。患者不知道治疗分配情况。统计学家在统计分析计划签署前对主要结局数据设盲。
使用混合效应逻辑回归分析，我们发现干预组（17%）和对照组（19%）在30天非计划再入院率方面无显著差异（比值比0.93；95%置信区间，0.78至1.10；P = 0.372）。在所有时间点，干预组的再入院率均较低。干预组的再入院总数在所有时间点均较低，在90天内达到统计学显著性，再入院人数比对照组少13%（发病率比值比：0.87；95%置信区间0.76至0.99）。仅在30天时，干预组患者报告的过渡体验更好，安全事件显著更少。两组均观察到类似的严重不良事件[YCNY组：26例（52.0%），常规护理组：24例（48.0%）]。均与治疗无关。
YCNY在第30天对非计划住院再入院率没有显著影响，但在一些次要结局指标上，我们确实发现了临床获益的证据。
