Klein G L, Kita K, Fish J, Sinkus B, Jensen G L
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, USA.
J Am Diet Assoc. 1997 Aug;97(8):885-8. doi: 10.1016/S0002-8223(97)00216-2.
Health care services and resources for older persons living in rural areas may be highly variable, and integrated service-delivery models are often lacking. This article presents a managed-care model of nutrition risk screening and intervention for older persons in rural areas. Nutrition risk screening was implemented by the Geisinger Health Care System, Danville, Pa, to target all eligible enrollees in a regional Medicare risk program. A single remote clinic site participating in the managed health care system was chosen for further study of a linked screening and case-management effort for undernourished persons. Screening and intervention at the clinic site selected for this study were guided by centralized expertise and resources. Individualized evaluation and intervention plans were developed with the aid of a dietitian and implemented by the clinic case manager. Of the 417 subjects who completed screening at the remote site, 68 met the risk criteria for undernutrition and were selected for case management. Many of the targeted persons received interventions that included evaluations by a physician or physician extender (eg, physician assistant, nurse practitioner) at the clinic and consultations with nutrition, mental health, or social services professionals. Twenty-six of the subjects who took part in the intervention completed a follow-up screening 6 months later. Ten of those persons no longer exhibited risk criteria. This demonstrates the feasibility of a linked screening and case management program for nutrition risk in the managed-care setting.
为农村地区老年人提供的医疗保健服务和资源可能差异很大，而且往往缺乏综合服务提供模式。本文介绍了一种针对农村地区老年人的营养风险筛查与干预的管理式医疗模式。宾夕法尼亚州丹维尔的盖辛格医疗保健系统实施了营养风险筛查，以针对区域医疗保险风险计划中的所有符合条件的参保人。选择了一个参与管理式医疗系统的偏远诊所进行进一步研究，以对营养不良者进行相关的筛查和病例管理。本研究选定的诊所地点的筛查和干预由集中的专业知识和资源指导。在营养师的帮助下制定个性化评估和干预计划，并由诊所病例管理员实施。在偏远地点完成筛查的417名受试者中，68人符合营养不良风险标准并被选入病例管理。许多目标人群接受了干预，包括在诊所由医生或医生助理（如医师助理、执业护士）进行评估，以及与营养、心理健康或社会服务专业人员进行咨询。参与干预的26名受试者在6个月后完成了随访筛查。其中10人不再表现出风险标准。这证明了在管理式医疗环境中开展营养风险关联筛查和病例管理项目的可行性。
