PDF(Pubmed)
Abstract：
BACKGROUND: The Coordinated medical Care (CoCare) project aimed to improve the quality of medical care in nursing homes by optimizing collaboration between nurses and physicians. We analyze the impact of the CoCare intervention on overall survival.
METHODS: The effect of time-varying treatment on 3-year overall survival was analyzed with treatment as time-varying covariate within the entire cohort. To reduce bias due to non-random assignment to treatment groups, regression adjustment was applied. Therefore, age, sex, and level of care were used as potential confounders.
RESULTS: The study population consisted of 8,893 nursing home residents (NHRs), of which 1,330 participated in the CoCare intervention. The three-year overall survival was 49.8% in the entire cohort. NHRs receiving the intervention were associated with a higher survival probability compared to NHRs of the control group. In a univariable cox model with time-dependent treatment, the intervention was associated with a hazard ratio of 0.70 [95%CI 0.56-0.87, p = 0.002]. After adjustment for age, sex and level of care, the hazard ratio increased to 0.82 but was still significant [95%CI 0.71-0.96, p = 0.011].
CONCLUSIONS: The analysis shows that optimizing collaboration between nurses and physicians leads to better survival of NHRs in Germany. This adds to the already published favorable cost-benefit ratio of the CoCare intervention and shows that a routine implementation of optimized collaboration between nurses and physicians is highly recommended.
METHODS: The effect of time-varying treatment on 3-year overall survival was analyzed with treatment as time-varying covariate within the entire cohort. To reduce bias due to non-random assignment to treatment groups, regression adjustment was applied. Therefore, age, sex, and level of care were used as potential confounders.
RESULTS: The study population consisted of 8,893 nursing home residents (NHRs), of which 1,330 participated in the CoCare intervention. The three-year overall survival was 49.8% in the entire cohort. NHRs receiving the intervention were associated with a higher survival probability compared to NHRs of the control group. In a univariable cox model with time-dependent treatment, the intervention was associated with a hazard ratio of 0.70 [95%CI 0.56-0.87, p = 0.002]. After adjustment for age, sex and level of care, the hazard ratio increased to 0.82 but was still significant [95%CI 0.71-0.96, p = 0.011].
CONCLUSIONS: The analysis shows that optimizing collaboration between nurses and physicians leads to better survival of NHRs in Germany. This adds to the already published favorable cost-benefit ratio of the CoCare intervention and shows that a routine implementation of optimized collaboration between nurses and physicians is highly recommended.
摘要：
背景：协调医疗（CoCare）项目旨在通过优化护士和医生之间的合作来提高疗养院的医疗质量。我们分析了CoCare干预对总生存期的影响。
方法：分析了随时间变化的治疗对3年总生存率的影响，并将治疗作为整个队列中随时间变化的协变量。为了减少由于非随机分配给治疗组造成的偏差，进行了回归调整。因此,年龄,性别,和护理水平被用作潜在的混杂因素。
结果：研究人群包括8,893名疗养院居民（NHRs），其中1,330人参加了CoCare干预。整个队列的三年总生存率为49.8%。与对照组的NHRs相比，接受干预的NHRs具有更高的生存概率。在具有时间依赖性治疗的单变量cox模型中，干预的风险比为0.70[95CI0.56-0.87,p=0.002].调整后的年龄，性别和护理水平，风险比增加至0.82,但仍然显著[95CI0.71-0.96,p=0.011].
结论：分析表明，优化护士和医生之间的合作可以提高德国NHRs的生存率。这增加了已经发布的CoCare干预措施的有利成本效益比，并表明强烈建议常规实施护士和医生之间的优化协作。
方法：分析了随时间变化的治疗对3年总生存率的影响，并将治疗作为整个队列中随时间变化的协变量。为了减少由于非随机分配给治疗组造成的偏差，进行了回归调整。因此,年龄,性别,和护理水平被用作潜在的混杂因素。
结果：研究人群包括8,893名疗养院居民（NHRs），其中1,330人参加了CoCare干预。整个队列的三年总生存率为49.8%。与对照组的NHRs相比，接受干预的NHRs具有更高的生存概率。在具有时间依赖性治疗的单变量cox模型中，干预的风险比为0.70[95CI0.56-0.87,p=0.002].调整后的年龄，性别和护理水平，风险比增加至0.82,但仍然显著[95CI0.71-0.96,p=0.011].
结论：分析表明，优化护士和医生之间的合作可以提高德国NHRs的生存率。这增加了已经发布的CoCare干预措施的有利成本效益比，并表明强烈建议常规实施护士和医生之间的优化协作。
