Effect of a Community-Based Nursing Intervention on Mortality in Chronically Ill Older Adults A Randomized Controlled Trial 英文参考文献.docVIP

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Effect of a Community-Based Nursing Intervention on Mortality in Chronically Ill Older Adults A Randomized Controlled Trial 英文参考文献.doc

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Effect of a Community-Based Nursing Intervention on Mortality in Chronically Ill Older Adults A Randomized Controlled Trial 英文参考文献

EffectofaCommunity-BasedNursingInterventionon MortalityinChronicallyIllOlderAdults:ARandomized ControlledTrial KennethD.Coburn*,SherryMarcantonio,RobertLazansky,MaryellenKeller,NancyDavis HealthQualityPartners,Doylestown,Pennsylvania,UnitedStatesofAmerica Abstract Background:Improvingthehealthofchronicallyillolderadultsisamajorchallengefacingmodernhealthcaresystems.A community-basednursinginterventiondevelopedbyHealthQualityPartners(HQP)wasoneof15differentmodelsofcare coordination tested in randomized controlled trials within the Medicare Coordinated Care Demonstration (MCCD), a nationalUSstudy.EvaluationoftheHQPprogrambeganin2002.Thestudyreportedherewasdesignedtoevaluatethe survivalimpactoftheHQPprogramversususualcareuptofiveyearspost-enrollment. MethodsandFindings:HQPenrolled1,736adultsaged65andover,withoneormoreeligiblechronicconditions(coronary arterydisease,heartfailure,diabetes,asthma,hypertension,orhyperlipidemia)duringthefirstsixyearsofthestudy.The interventiongroup(n=873)wasofferedacomprehensive,integrated,andtightlymanagedsystemofcarecoordination, diseasemanagement,andpreventiveservicesprovidedbycommunity-basednursecaremanagersworkingcollaboratively with primary care providers. The control group (n=863) received usual care. Overall, a 25% lower relative risk of death (hazardratio[HR]0.75[95%CI0.57–1.00],p=0.047)wasobservedamonginterventionparticipantswith86(9.9%)deathsin theinterventiongroupand111(12.9%)deathsinthecontrolgroupduringameanfollow-upof4.2years.Whencovariates forsex,agegroup,primarydiagnosis,perceivedhealth,numberofmedicationstaken,hospitalstaysinthepast6months, and tobacco use were included, the adjusted HR was 0.73 (95% CI 0.55–0.98, p=0.033). Subgroup analyses did not demonstrate statistically significant interaction effects for any subgroup. No suspected program-related adverse events wereidentified. Conclusions: The HQP model of community-based nurse care management appeared to reduce all-cause mortality in chronicallyillolderadults.Limi