住院老年共病患者多学科延续性管理模式研究

目的构建住院老年共病患者的多学科延续性管理模式,并进行成效分析,为老年共病患者的管理提供参考和建议。方法前瞻性随机对照研究。选择2015年11月至2017年7月于我院老年病区住院治疗,年龄≥60岁共病患者,均接受老年综合评估(CGA)。随机分为接受多学科延续性医疗的干预组和接受传统医疗的对照组。总结干预组工作流程及特点,分析比较两种模式作用效果(包括住院花费、时间和患者治疗满意度以及随访6个月后的患者功能状态、不良事件发生和健康行为意识改变)。结果研究共纳入440例共病患者,年龄(76.0±8.1)岁,其中干预组226例,对照组214例。经多学科延续医疗干预,干预组患者对获得医生帮助(86.3%比74.8%,χ2=9.354,P=0.002)、获得所需医疗照护(99.6%比86.7%,χ2=4.926,P=0.026)和对护理质量满意度(93.4%比86.4%,χ2=5.829,P=0.016)高于对照组。随访6个月后,干预组发生不良结局事件的概率低于对照组(61.1%比73.5%,χ2=7.436,P=0.006),其中干预组药物相关的不良反应/事件(9.0%比22.1%,χ2=13.858,P<0.000)明显低于对照组;干预组患者健康行为意识改善比例高于对照组(30.3%比5.4%,χ2=43.979,P<0.001)。结论以CGA为核心的多学科的医院社区延续性管理模式能减少不良事件发生,提高患者满意度,并改善健康行为意识,是老年共病患者医疗新模式的探索。

Study on a multidisciplinary continuing management model for hospitalized elderly patients with multimorbidity

Objective To construct a multidisciplinary continuing management model for hospitalized elderly patients with multimorbidity and to assess the effectiveness of this model,thus providing insights and suggestions for the management of elderly patients with co-morbidity.Methods This was a prospective randomized controlled study.Patients with comorbidity admitted to the geriatric ward of our hospital from November 2015 to July 2017 were selected and received comprehensive geriatric assessment(CGA).Patients were randomly divided into the intervention group receiving continuous multidisciplinary medical treatment and the control group receiving conventional medical treatment.The work flow and characteristics of the intervention group were examined,and the effectiveness of the two models(including cost of hospitalization,duration,patient satisfaction,patient functional status,adverse events,and changes in healthy behavior awareness after 6 months of follow-up)were compared between the two groups.Results A total of 440 patients with comorbidity were included in the study,with an average age of(76.0±8.1)years,including 226 in the intervention group and 214 in the control group.After multidisciplinary continuing medical intervention,patients in the intervention group were associated with a significantly higher level of satisfaction on physician availability(86.3%vs.74.8%,χ2=9.354,P=0.002),medical care(99.6%vs.86.7%,χ2=4.926,P=0.026)and nursing quality(93.4%vs.86.4%,χ2=5.829,P=0.016),compared with the control group.After 6 months of follow-up,the probability of adverse events in the intervention group was lower than that in the control group(61.1%vs.73.5%,χ2=7.436,P=0.006),and drug-related adverse reactions/events in the intervention group(9.0%vs.22.1%,χ2=13.858,P<0.000)were significantly lower than those in the control group.Furthermore,the proportion of patients with improved healthy behavior awareness was markedly higher in the intervention group than that in the control group(30.3%vs.5.4%,χ2=43.979,P<0.001).Conclusions The multidisciplinary hospital-community continuity management model with CGA at the core can reduce the occurrence of adverse events,improve patient satisfaction and healthy behavior awareness,and is a worthy exploration of a new medical model for elderly comorbid patients.