医疗保健代理人的认知度和完成率有显著提高。一项关于医院患者代表咨询的随机对照试验。

Marked improvement in recognition and completion of health care proxies. A randomized controlled trial of counseling by hospital patient representatives.

作者信息

Meier D E, Fuss B R, O'Rourke D, Baskin S A, Lewis M, Morrison R S

机构信息

Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, NY.

出版信息

Arch Intern Med. 1996 Jun 10;156(11):1227-32.

PMID:8639017

Abstract

BACKGROUND

Advance directives provide a means for patients to retain influence on their medical care should decisional capacity be lost. Several studies have now demonstrated that advance directives that are completed in the ambulatory care setting are rarely available and recognized when patients are admitted to the acute care hospital.

OBJECTIVE

To evaluate a generalizable model for improving recognition of previously completed advance directives and for promoting appointment of health care proxies in hospitalized patients.

METHODS

Hospitalized elderly patients were randomly assigned to receive the intervention or usual care (n = 190). Intervention patients with capacity were counseled by hospital patient representatives about advance directives and encouraged to complete health care proxies. Patients with existing proxies had this information noted in their charts. For patients without capacity, counselors reviewed their charts for proxy documentation and if absent, contacted patients' next of kin and private physicians to determine proxy status. Usual care patients were not contacted by patient representatives.

RESULTS

Forty-eight percent of intervention patients completed a new proxy or had a previously completed proxy identified compared with 6% of controls (P < .001). For patients with capacity, 22% of intervention patients had a previously appointed proxy agent identified compared with 6% of controls (P < .001). Thirty-six percent of intervention patients appointed a proxy decision maker compared with 0% of controls (P < .02). For patients without capacity, 31% of intervention patients had previously appointed proxies identified compared with 6% of controls (P < .001).

CONCLUSIONS

Counseling by hospital patient representatives is an effective and generalizable means of improving recognition and execution of advance directives in the acute care hospital.

摘要

背景

预先指示为患者在丧失决策能力时对其医疗护理保留影响力提供了一种方式。现在有几项研究表明，在门诊护理环境中完成的预先指示在患者入住急症医院时很少能被获取和识别。

目的

评估一种可推广的模式，以提高对先前完成的预先指示的识别，并促进住院患者指定医疗代理人。

方法

将住院老年患者随机分配接受干预或常规护理（n = 190）。有行为能力的干预组患者由医院患者代表就预先指示进行咨询，并被鼓励指定医疗代理人。已有代理人的患者，此信息会记录在其病历中。对于无行为能力的患者，咨询人员会查看其病历以寻找代理人文件记录，若没有，则联系患者的近亲及私人医生以确定代理人情况。常规护理组患者未接受患者代表的联系。

结果

48%的干预组患者完成了新的代理人指定或识别出先前已完成的代理人指定，而对照组为6%（P < .001）。对于有行为能力的患者，22%的干预组患者识别出先前指定的代理代理人，而对照组为6%（P < .001）。36%的干预组患者指定了代理决策者，而对照组为0%（P < .02）。对于无行为能力的患者，31%的干预组患者识别出先前指定的代理人，而对照组为6%（P < .001）。