Rosswurm M A, Lanham D M
Center for Nursing Research, Camcare Health Education and Research Institute, Charleston, WV 25304, USA.
J Gerontol Nurs. 1998 May;24(5):14-21. doi: 10.3928/0098-9134-19980501-08.
The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources. The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.
老年人群中常见的复杂慢性健康问题和功能受限使他们面临复杂住院治疗和出院计划的风险。本研究的目的是调查出院计划方案在识别老年患者家庭护理需求方面的有效性。这项准实验研究的样本包括507名65岁及以上的住院患者。对照组接受常规的医院出院计划方案。在实验组中，护士/社会工作者团队协调出院计划流程，使用改编后的出院计划问卷（DPQ）来识别老年患者的家庭护理需求。出院30天后，两个患者组都参与了电话调查，以获取有关他们在家康复期间遇到的医疗保健问题以及他们对医疗保健资源使用情况的信息。研究结果表明，大多数老年患者存在功能依赖，这需要他人帮助才能完成日常家务并提供基本需求方面的协助，尤其是行走方面。这些功能依赖的患者仅在约50%的时间里获得了家庭护理转诊。这些发现引发了关于当前可报销服务的问题。逻辑回归分析表明，功能依赖增加以及在家康复期间出现患者问题的患者再次住院和使用急诊科的可能性更大。这些关于老年患者住院后家庭护理的信息支持了将全面功能评估作为出院计划一部分的必要性。本研究还表明，护士/社会工作者团队可以提供有效的家庭护理筛查和出院计划协调。必须有医生的参与和有效的沟通网络。
