手术住院患者中的 GeriNOT。

Birgit Feindt, Andreas Roth, Christoph-Eckhard Heyde, Johann Behrens, Beate Feist, Lysann Kasprick, Ralf Sultzer, Christoph Baerwald
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引用次数: 0

摘要

联邦联合委员会(G-BA)关于髋部骨折患者护理质量评估措施的指导方针规定,医院在急诊住院患者护理中必须使用适当的老年病筛查工具。在将 GeriNOT 和数据收集系统应用于入院流程并整合到医院信息系统(HIS)后,还可以识别患有其他诊断的老年病患者的潜在风险。随着 GeriNOT 被整合到急性住院病人的入院流程中,研究人员对患有其他诊断的易感老年病患者是否能从早期启动的风险识别中获益进行了考察。本研究的数据基础是电子病例记录的回顾性双中心收集(2014 年 5 月至 2015 年 4 月,n = 3443)。从这一原始数据集中,对研究中心骨科/创伤外科的急性住院病人亚组(n = 821)进行了分析,并就终点 "基于需求的住院后护理服务利用率 "和 "新入院长期/短期护理 "进行了评估。研究评估了 GeriNOT 对这些 70 岁及以上患者的预测能力和分类准确性,包括以下几组:急性住院病人总数、骨折总数、髋部骨折和脊柱疾病(包括脊柱骨折)。患者的平均年龄为 81.4 ± 6.8 岁(n = 821;68.1% 为女性,31.9% 为男性)。研究人员对以下分组进行了分析:全骨折(n = 490)、脊柱疾病(n = 265)(包括脊柱骨折(n = 174))和髋部骨折(n = 108)。无论是在总体组(n = 821;M = 4.279;SD = 2.180)还是在分组中,GeriNOT 的平均得分都高于阈值 ≥ 4。得分最高的是髋部骨折组(M = 4.852; SD = 2.022),最低的是脊柱骨折组(M = 4.177; SD = 2.171)。入院时,如果将需要治疗的变量条件定为 "多种药物 "和 "已根据需要使用护理服务",则诊断组之间仅存在轻微差异。从短期和长期护理入院的病例占总病例数的 16.44%,其中以髋部骨折入院的病例最多,占 31.48%,而脊柱疾病入院的病例仅占 6.79%。在这一组中,GeriNOT 检测到与定义终点相关的风险升高。结果显示,在所有分析组别中,老年病风险都有所增加,但在脊柱疾病组别中最为明显。在 HIS 系统的支持下,GeriNOT 的使用为急性住院病人的入院管理提供了系统性风险识别的可能性。在整个工作流程中,HIS 工作站对结果的持续可视化可作为后续应用标准化评估工具和风险调整治疗路径的起点。这些研究结果有可能改善治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
GeriNOT in the Surgical Inpatient Setting.

The guideline of the Federal Joint Committee (G-BA) on quality assessment measures for the care of patients with hip fracture makes it mandatory for hospitals to use an appropriate geriatric screening instrument in the context of acute inpatient care. After systematic application of GeriNOT and data collection in the admission process with integration into the Hospital Information System (HIS), it is possible to identify potential risks in geriatric patients with other diagnoses as well.With the integration of GeriNOT into the acute inpatient admission process, it was examined whether vulnerable geriatric patients with other diagnoses could benefit from the early initiation of risk identification.The data base for the present study was a retrospective bicentric collection of electronic case records (May 2014 to April 2015, n = 3,443). From this primary data set, the subgroup of inpatient acute admissions (n = 821) in the orthopaedic/trauma surgery of a study centre was analysed and evaluated with respect to the endpoints "utilisation of needs-based post-inpatient care services" and "new admission to inpatient permanent/short-term care". The predictive power and classification accuracy of GeriNOT of these patients who were 70 years and older to the endpoints were assessed for several groups: total acute admissions, total fractures, hip fracture, and spinal disorders including spinal fractures.A total of 821 patients were admitted as acute inpatients during the study period. The mean age of the patients was 81.4 ± 6.8 years (n = 821; 68.1% women, 31.9% men). The following subgroups were formed and analysed: total fractures (n = 490), spinal disorders (n = 265) including spinal fractures (n = 174), and hip fracture (n = 108). Both in the overall group (n = 821; M = 4.279; SD = 2.180) and in the subgroups, the mean GeriNOT score was above the threshold ≥ 4. The highest score was found in the hip fracture group (M = 4.852; SD = 2.022), and the lowest in the spine fracture group (M = 4.177; SD = 2.171). At admission, if the terms of variables for requiring treatment were "polypharmacy" and "nursing services already used as needed", there were only slight differences in the diagnostic groups. Admissions from short-term and long-term care occurred in the total group in 16.44% of cases, most frequently with 31.48% in the group of hip fractures, compared to spinal diseases with 6.79%. For this group, GeriNOT detected an elevated risk with respect to the defined endpoints. However, only 4.26% of all patients with identified geriatric risk potential received further geriatric care.The results showed increased geriatric risk in all analysed groups, but most pronouncedly within the group of spinal diseases. The HIS-supported use of GeriNOT offers the possibility of systematic risk identification in acute inpatient admission management. The continuous visualisation of results at HIS workstations throughout the workflow could be used as a starting point for the subsequent application of standardized assessment tools and risk-adjusted treatment pathways. These findings could potentially improve outcomes.

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