Leff B, Burton L, Bynum J W, Harper M, Greenough W B, Steinwachs D, Burton J R
Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
J Am Geriatr Soc. 1997 Sep;45(9):1066-73. doi: 10.1111/j.1532-5415.1997.tb05968.x.
To evaluate criteria to select older persons who need hospitalization for common acute medical illnesses for care in a hypothetical home hospital.
Prospective record review.
Patients aged 65 and older admitted to the general medical service of a community-based university hospital.
We developed illness-specific selection criteria to identify older persons with certain acute medical conditions for treatment in a hypothetical home hospital. The selection criteria were reviewed prospectively against all community-dwelling older patients admitted to the general medical service of a community-based university hospital over a 2-month period. We determined eligibility for home hospital admission based on information available at the time of admission and then tracked the patient's hospital course.
One hundred fifty-seven admissions of 143 patients were reviewed. The selection criteria identified 33% of patients admitted to the acute hospital with one of the three target diagnoses as eligible for a home hospital model of care had it been available. Eligible patients experienced shorter lengths of stay (3.7 vs 5.4 days, P = .012), fewer mean number of procedures performed (0.98 vs 1.70, P = .001), fewer mean number of complications (0.17 vs 0.56, P = .010), and fewer events that could be handled only in the acute hospital setting (P = .036). In addition, in logistic regression analysis, three criteria for home hospital ineligibility, pulmonary congestion associated with ischemic chest pain (odds ratio 6.85, 95% CI 2.64, 17.81), the presence of an acute coexisting illness requiring hospitalization independent of the target conditions (odds ratio 2.66, 95% CI 1.11, 6.41), and significant pulmonary congestion after initial treatment (odds ratio 14.4, 95% CI 1.77, 117.41) were significantly associated with items difficult to accomplish at home.
Criteria can be delineated that identify older persons with acute medical illnesses who may be suitable for treatment in a home hospital.
评估在假设的居家医院中，为因常见急性内科疾病而需住院治疗的老年人选择合适治疗方式的标准。
前瞻性记录回顾。
65岁及以上入住一所社区大学医院普通内科的患者。
我们制定了针对特定疾病的选择标准，以确定患有某些急性内科疾病的老年人是否适合在假设的居家医院接受治疗。在两个月的时间里，我们根据这些选择标准对所有入住该社区大学医院普通内科的社区居住老年患者进行了前瞻性评估。我们根据入院时可获取的信息确定患者是否符合居家医院入院条件，然后跟踪患者的住院病程。
对143例患者的157次入院情况进行了回顾。选择标准显示，在因三种目标诊断之一而入住急症医院的患者中，若有居家医院护理模式，33%的患者符合条件。符合条件的患者住院时间较短（3.7天对5.4天，P = 0.012），平均进行的操作数量较少（0.98次对1.70次，P = 0.001），平均并发症数量较少（0.17个对0.56个，P = 0.010），且仅在急症医院环境中才能处理的情况较少（P = 0.036）。此外，在逻辑回归分析中，居家医院不符合条件的三个标准，即与缺血性胸痛相关的肺充血（比值比6.85，95%置信区间2.64, 17.81）、存在独立于目标疾病需要住院治疗的急性并存疾病（比值比2.66，95%置信区间1.11, 6.41）以及初始治疗后严重肺充血（比值比14.4，95%置信区间1.77, 117.41），均与在家中难以完成的项目显著相关。
可以划定标准，以识别可能适合在居家医院接受治疗的患有急性内科疾病的老年人。
