随着我们日益老龄化的住院人口的复杂性,我们对住院医师实施了跨专业的老年和姑息治疗干预.本研究旨在衡量干预措施对住院时间(LOS)的影响,重新接纳30天,以及住院服务利用的每日强度。
在拥有1000张床位的美国四级学术医学中心使用非随机对照干预措施,我们研究了13,941名接受普通医学医院服务的患者(其中5644人年龄>=65岁);1483人在干预小组中(576人年龄>=65岁),5413个并发控制,和7045个历史控件。在11个医院团队中的2个中,一个老年病学家,姑息治疗医生和社会工作者每周两次参加多学科出院检查,建议住院老年或姑息治疗咨询(GPCC),急性护理或家庭护理,与出院后门诊咨询相比。我们测量了以下干预组和对照组患者随时间的改善差异:(1)根据病例组合指数调整的LOS,(2)30天再入院,和(3)医院服务利用强度(每位患者每天提供的平均服务)。
干预组1483名患者的调整后LOS(住院天数)减少了0.36天(p=0.039),在576例老年患者中,每次入院的LOS平均减少0.55天(p=0.022)。再入院率没有变化(-1.17%,所有患者p=0.48;1.91%,老年患者的p=0.46)。然而,每日相对价值单位(RVU)利用率在整体和较老的亚组都略有增加,干预团队平均每患者日0.35个RVU(p=0.041)和0.74个RVU(p<0.001),分别。
与医院服务机构合作的老年和姑息治疗咨询的跨专业干预可能会降低LOS,特别是对于老年病人,而不会增加再入院。该模型可能对医院护理具有更广泛的意义,应进一步研究。
With increasing complexity of our aging inpatient population, we implemented an interprofessional geriatric and palliative care intervention on a hospitalist service. This study aimed to measure the intervention\'s impact on length of stay (LOS), 30-day readmission, and the daily intensity of inpatient services utilization.
Using a nonrandomized controlled intervention at a 1000-bed U.S. academic quaternary medical center, we studied 13,941 individuals admitted to a general medicine hospitalist service (of which 5644 were age > =65 years); 1483 were on intervention teams (576 age > =65 years), 5413 concurrent controls, and 7045 historical controls. On 2 of 11 hospitalist teams, a geriatrician, palliative care physician and social worker attended multidisciplinary discharge rounds twice weekly, to recommend inpatient geriatric or palliative care consult (GPCC), postacute nursing or home care, versus postdischarge outpatient consultation. We measured the difference in improvement over time between intervention and control team patients for the following: (1) LOS adjusted for case-mix index, (2) 30-day readmissions, and (3) intensity of hospital service utilization (mean services provided per patient per day).
Adjusted LOS (in hospital days) was decreased by 0.36 days (p = 0.039) for the 1483 patients in the intervention teams, with greater LOS reduction of 0.55 days per admission (p = 0.022) on average among the subset of 576 older patient admissions. Readmissions were unchanged (-1.17%, p = 0.48 for all patients; 1.91%, p = 0.46 for older patients). However, the daily relative value unit (RVU) utilization was modestly increased for both the overall and older subgroup, 0.35 RVUs (p = 0.041) and 0.74 RVUs (p < 0.001) per patient-day on average across the intervention teams, respectively.
An interprofessional intervention of geriatric and palliative care consultation in collaboration with a hospitalist service may reduce LOS, especially for geriatric patients, without an increase in readmissions. This model may have broader implications for hospital care and should be further studied.