一项针对复杂跨专业干预（interprofACT）以减少养老院居民住院的整群随机试验。

Cluster randomised trial of a complex interprofessional intervention (interprof ACT) to reduce hospital admission of nursing home residents.

机构信息

Department of General Practice, University Medical Center Göttingen, Göttingen D-37073, Germany.

Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany.

出版信息

Age Ageing. 2023 Mar 1;52(3). doi: 10.1093/ageing/afad022.

DOI:10.1093/ageing/afad022

PMID:36934341

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10024891/

Abstract

BACKGROUND

Some hospital admissions of nursing home residents (NHRs) might be attributed to inadequate interprofessional collaboration. To improve general practitioner-nurse collaboration in nursing homes (NHs), we developed an intervention package (interprof ACT) in a previous study.

OBJECTIVE

To assess the impact of interprof ACT on the proportion of hospitalisation and other clinical parameters within 12 months from randomisation among NHRs.

METHODS

Multicentre, cluster randomised controlled trial in 34 German NHs. NHRs of the control group received usual care, whereas NHRs in the intervention group received interprof ACT. Eligible NHs had at least 40 long-term care residents. NHs were randomised 1:1 pairwise. Blinded assessors collected primary outcome data.

RESULTS

Seventeen NHs (320 NHRs) were assigned to interprof ACT and 17 NHs (323 NHRs) to usual care. In the intervention group, 136 (42.5%) NHRs were hospitalised at least once within 12 months from randomisation and 151 (46.7%) in the control group (odds ratio (OR): 0.82, 95% confidence interval (CI): [0.55; 1.22], P = 0.33). No differences were found for the average number of hospitalisations: 0.8 hospitalisations per NHR (rate ratio (RR) 0.90, 95% CI: [0.66, 1.25], P = 0.54). Average length of stay was 5.7 days for NHRs in the intervention group and 6.5 days in the control group (RR: 0.70, 95% CI: [0.45, 1.11], P = 0.13). Falls were the most common adverse event, but none was related to the study intervention.

CONCLUSIONS

The implementation of interprof ACT did not show a statistically significant and clinically relevant effect on hospital admission of NHRs.

摘要

背景

一些养老院居民（NHR）的住院可能归因于专业间协作不足。为了改善养老院（NH）中全科医生与护士的协作，我们在之前的研究中开发了一个干预包（interprof ACT）。

目的

评估 interprof ACT 对随机分组后 12 个月内 NHR 住院率和其他临床参数的影响。

方法

在德国 34 家 NH 进行了一项多中心、集群随机对照试验。对照组的 NHR 接受常规护理，而干预组的 NHR 则接受 interprof ACT。符合条件的 NH 至少有 40 名长期护理居民。NH 以 1:1 对的方式随机分组。盲法评估者收集主要结局数据。

结果

17 家 NH（320 名 NHR）被分配到 interprof ACT 组，17 家 NH（323 名 NHR）被分配到常规护理组。在干预组中，有 136 名（42.5%）NHR 在随机分组后 12 个月内至少住院一次，而对照组中有 151 名（46.7%）（比值比（OR）：0.82，95%置信区间（CI）：[0.55；1.22]，P = 0.33）。住院次数的平均数量没有差异：每位 NHR 住院 0.8 次（率比（RR）0.90，95%CI：[0.66，1.25]，P = 0.54）。干预组 NHR 的平均住院时间为 5.7 天，对照组为 6.5 天（RR：0.70，95%CI：[0.45，1.11]，P = 0.13）。跌倒是最常见的不良事件，但没有一起与研究干预有关。