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.
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。