Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M
University of Pennsylvania, Philadelphia.
Ann Intern Med. 1994 Jun 15;120(12):999-1006. doi: 10.7326/0003-4819-120-12-199406150-00005.
To study the effects of a comprehensive discharge planning protocol, designed specifically for the elderly and implemented by nurse specialists, on patient and caregiver outcomes and cost of care.
Randomized clinical trial.
Hospital of the University of Pennsylvania.
276 patients and 125 caregivers. Patients were 70 years and older and were placed in selected medical and surgical cardiac diagnostic-related groups.
Group differences in patient outcomes (length of initial hospital stay, length of time between initial hospital discharge and readmission, and rehospitalization rates) and charges for care (charges for initial hospitalization, rehospitalizations, health services after discharge, and nurse specialist services) were measured 2, 6, and 12 weeks after discharge.
From the initial hospital discharge to 6 weeks after discharge, patients in the medical intervention group had fewer readmissions, fewer total days rehospitalized, lower readmission charges, and lower charges for health care services after discharge. No differences in these outcomes were found between the surgical intervention and control groups during this period.
Study findings support the need for comprehensive discharge planning designed for the elderly and implemented by nurse specialists to improve their outcomes after hospital discharge and to achieve cost savings. The findings also suggest that this intervention had its greatest effect in delaying or preventing rehospitalization of patients in the medical intervention group during the first 6 weeks after discharge.
研究由护士专家专门为老年人设计并实施的综合出院计划方案对患者及照料者的结局以及护理成本的影响。
随机临床试验。
宾夕法尼亚大学医院。
276名患者及125名照料者。患者年龄在70岁及以上，被纳入选定的内科和外科心脏诊断相关分组。
在出院后2周、6周和12周测量患者结局（首次住院时长、首次出院至再次入院的时间间隔以及再住院率）和护理费用（首次住院费用、再住院费用、出院后医疗服务费用以及护士专家服务费用）的组间差异。
从首次出院至出院后6周，内科干预组患者的再入院次数更少、再住院总天数更少、再入院费用更低且出院后医疗服务费用更低。在此期间，外科干预组与对照组在这些结局方面未发现差异。
研究结果支持有必要开展由护士专家为老年人设计并实施的综合出院计划，以改善他们出院后的结局并实现成本节约。研究结果还表明，该干预措施在出院后的前6周对延缓或预防内科干预组患者的再住院具有最大效果。
