背景:需要新的医院转移策略来支持越来越多的社区痴呆症患者。一个有前途的模型是社区参数医学(CP),将护理人员部署到家里,咨询医生以协调治疗和评估处置。虽然有证据表明CP可以在不升级到急诊科(ED)的情况下管理许多患者,尚无研究评估痴呆患者的最佳CP利用率.因此,我们比较了患有和不患有痴呆的患者在家中使用CP的情况和结局.
方法:这项回顾性队列研究检查了251名接受家庭基础初级保健的家庭患者,在2017年3月至2022年5月期间使用医生主导的CP服务。链接的电子健康记录数据包括患者人口统计,临床特征,和CP遇到细节。痴呆状态和CP结果,包括ED运输费率,过度运输(即,运输,但没有住院),和运输不足(即,不运输,但ED在3天内访问),是通过图表审查确定的。使用逻辑回归,我们对痴呆状态与过度运输和运输不足的关系进行了建模,调整年龄,性别,主要投诉。
结果:53%的CP患者患有痴呆。他们最常见的主诉是呼吸困难(24.3%),精神状态改变(17.9%),和普遍疲软(9.8%)。我们发现不同痴呆状态的ED转运率没有显着差异(25.4与22.8%,p=0.54)。在调整后的模型中,痴呆诊断与较低的过度转运率(OR=0.21,p=0.03,CI[0.05,0.85])和相当的低转运率(OR=0.70,p=0.47,CI[0.27,1.83])相关。
结论:CP有效地管理了通过基于家庭的初级保健治疗的不同家庭痴呆患者。未来的工作应该检查潜在的成本节约和CP在跨地理和医疗保健环境的痴呆症护理中的使用。
BACKGROUND: Novel hospital diversion strategies are needed to support a growing number of patients with dementia living in the community. One promising model is community paramedicine (CP), which deploys paramedics to the home, who consult with a physician to coordinate treatment and assess disposition. While evidence suggests CP can manage many patients without escalation to the emergency department (ED), no studies have evaluated optimal CP utilization for patients with dementia. Therefore, we compare the use and outcomes of CP for homebound patients with and without dementia.
METHODS: This retrospective cohort study examines 251 homebound patients receiving home-based primary care, who utilized a physician-led CP service between March 2017 and May 2022. Linked electronic health record data included patient demographics, clinical characteristics, and CP encounter details. Dementia status and CP outcomes, including rates of ED transport, over-transport (i.e., transported, but not hospitalized), and under-transport (i.e., not transported, but ED visit within 3 days), were determined via chart review. Using logistic regression, we modeled the association of dementia status with over- and under-transport, adjusting for age, sex, and chief complaint.
RESULTS: Fifty-three percent of CP patients had dementia. Their most common chief complaints were dyspnea (24.3%), altered mental status (17.9%), and generalized weakness (9.8%). We found no significant difference in ED transport rates by dementia status (25.4 vs. 22.8%, p = 0.54). Dementia diagnosis was associated with lower rates of over-transport (OR = 0.21, p = 0.03, CI [0.05, 0.85]) and comparable rates of under-transport (OR = 0.70, p = 0.47, CI [0.27, 1.83]) in adjusted models.
CONCLUSIONS: CP has effectively managed a diverse population of homebound patients with dementia cared for via home-based primary care. Future work should examine potential cost savings and use of CP in dementia care across geographic and healthcare settings.