Siu A L, Morishita L, Blaustein J
Department of Medicine, UCLA.
J Am Geriatr Soc. 1994 Oct;42(10):1094-9. doi: 10.1111/j.1532-5415.1994.tb06215.x.
To assess the effectiveness of comprehensive geriatric assessment conducted in day hospitals.
Retrospective cohort comparison study with restricted inclusionary criteria and adjustment for baseline characteristics.
A hospital-based geriatric day hospital and geriatric clinic sites (both in the university and in the community).
Four hundred sixty-eight patients referred for comprehensive geriatric assessment during a 12-month period.
Comprehensive geriatric assessment in a geriatric day hospital compared with assessment received in clinic sites without a day hospital.
Services received in the first 2 weeks; hospitalization, emergency room visits, placement, death, and change in selected health status measures. Follow-up data was obtained from medical records, a telephone survey, and death certificates.
Except in the case of rehabilitative services, day hospital patients were more likely to receive interdisciplinary services. The population seen in the day hospital was more functionally impaired and had significantly more dementia and depression. After adjusting for subjects' baseline characteristics and limiting the analyses to subjects meeting specific inclusionary criteria, the day hospital had no significant effect on mortality, use of emergency or hospital services, placement, or change on selected measures of health status. For example, compared with the clinic patients, receiving care in the day hospital was associated with an adjusted odds ratio of 1.01 (95% confidence interval: 0.53, 1.91) of being at a higher level of care at 6 months. The results were not sensitive to the choice of inclusionary criteria.
Given their cost and uncertain effectiveness, day hospitals need additional evaluation before their further diffusion occurs.
评估日间医院开展的综合老年评估的有效性。
采用回顾性队列比较研究，设定严格的纳入标准并对基线特征进行调整。
一家基于医院的老年日间医院以及老年诊所（包括大学和社区中的诊所）。
在12个月期间转诊接受综合老年评估的468名患者。
在老年日间医院进行综合老年评估，并与未设日间医院的诊所所提供的评估进行比较。
头两周接受的服务；住院、急诊就诊、安置情况、死亡以及选定健康状况指标的变化。随访数据来自医疗记录、电话调查和死亡证明。
除康复服务外，日间医院的患者更有可能接受多学科服务。在日间医院接受治疗的人群功能障碍更严重，痴呆和抑郁症的患病率也显著更高。在对受试者的基线特征进行调整并将分析局限于符合特定纳入标准的受试者后，日间医院对死亡率、急诊或住院服务的使用、安置情况或选定健康状况指标的变化没有显著影响。例如，与诊所患者相比，在日间医院接受护理的患者在6个月时接受更高水平护理的调整优势比为1.01（95%置信区间：0.53，1.91）。结果对纳入标准的选择不敏感。
鉴于其成本和效果的不确定性，日间医院在进一步推广之前需要进行更多评估。
