Konings J W, Danse J A, Wendte J F, Ribbe M W
EMGO, Vakgroep Huisarts-, Verpleeghuis- en Sociale Geneeskunde, Vrije Universiteit te Amsterdam.
Tijdschr Gerontol Geriatr. 1996 Oct;27(5):197-205.
The objective of the study was to establish in which way nursing home patients, for whom is refrained from hospitalization, differ from hospitalized nursing home patients. The question was also raised of how the decision to refrain from hospitalization is taken: which point of view and method the nursing home physician has, on which arguments decisions are based and which parties are involved and in which way. The design of the study was retrospective and descriptive. Data obtained from semi-structured interviews held in 1987 with 24 nursing home physicians on 45 situations were compared with registration data on 387 hospitalizations of patients from 30 nursing homes. In the non-hospitalized patients malignancies were relatively more frequent than in the hospitalized patients (29% versus 7%). The mean age of hospitalized patients was 78 and of non-hospitalized patients 80 years. The physical condition of non-hospitalized patients was more frequently judged as poor and the life expectancy as more limited. Already at an early stage nursing home physicians appeared to have a point of view, with which they determined the decision making procedure: in favour of (40%), opposing (35%) and in doubt of hospitalization (25%). In 'non-hospitalizations' there was much more involvement in decision making of family members and nurses, and less involvement of patients and medical specialists than in decisions to hospitalization. Non-medical arguments opposing hospitalization had slightly the upper hand above medical arguments. The decisive arguments opposing hospitalization were in the case of psychogeriatric patients more often of medical origin than in the case of somatic patients. The 'quality of live' mentioned arguments were of limited importance. The nursing home physician needs good communicative qualities in such decision making processes. He has to be skilled to judge competency of patients and, if needed, to balance in the right way the information of relatives, nurses, colleagues and specialists.
该研究的目的是确定那些未住院的疗养院患者与住院的疗养院患者在哪些方面存在差异。还提出了关于不进行住院治疗的决定是如何做出的问题：疗养院医生持何种观点和方法，决策基于哪些论据，涉及哪些方面以及以何种方式。该研究的设计是回顾性和描述性的。将1987年对24名疗养院医生就45种情况进行的半结构化访谈所获得的数据，与来自30家疗养院的387例患者住院登记数据进行了比较。在未住院患者中，恶性肿瘤的发生率相对高于住院患者（29%对7%）。住院患者的平均年龄为78岁，未住院患者为80岁。未住院患者的身体状况更常被判定为较差，预期寿命更有限。早在早期阶段，疗养院医生似乎就有了一种观点，他们据此确定决策程序：赞成（40%）、反对（35%）和对住院持怀疑态度（25%）。在“不进行住院治疗”的情况中，家庭成员和护士在决策中的参与度比住院决策时更高，而患者和医学专家的参与度更低。反对住院的非医学论据略多于医学论据。反对住院的决定性论据在老年精神科患者中比在躯体疾病患者中更常源于医学方面。所提及的“生活质量”论据重要性有限。疗养院医生在这样的决策过程中需要具备良好的沟通能力。他必须善于判断患者的能力，并在需要时以正确的方式权衡亲属、护士、同事和专家提供的信息。
