社区急性护理小组对与卫生保健系统急性接触频率的潜在相互作用：中断时间序列分析

IF 13.4 Q1 GERIATRICS & GERONTOLOGY

Lancet Healthy Longevity Pub Date : 2025-04-01 DOI:10.1016/j.lanhl.2025.100694

Stine Emilie Junker Udesen MScPH , Prof Annmarie Touborg Lassen MD , Prof Jens Søndergaard MD , Nina Andersen RN , Prof Søren Mikkelsen MD , Søren Bie Bogh PhD

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引用次数: 0

摘要

背景：人口老龄化要求对保健服务采取创新办法。2018年，丹麦引入了法定的市政急性护理，作为社区医疗保健的一部分，以改善对有复杂健康需求的成年人的护理。我们评估了欧登塞急救小组（ATO）在以下方面的潜在相互作用：(1)急性医院接触；(2)医院急性接触者因特殊感染诊断、高钠血症、精神错乱或神志不清所致；(3)紧急救护运输。方法在这项基于人群的回顾性纵向研究中，我们采用中断时间序列分析来评估2015年1月1日至2019年2月28日欧登塞市成年人ATO的相关性。采用亚组分析的方法，对80岁及以上的老年人、养老院居民以及在家或养老院生活的人的数据进行了检查。研究结果ATO治疗的患者年龄较大，有更多的合并症，并且比平均人口更依赖于市政医疗保健。ATO的实施与每月急性医院接触率没有统计学上的显著相关性，但与特异性感染诊断、高钠血症、谵妄或精神错乱（- 2.8 [95% CI - 5.5至- 0.1]）和急性救护车运送（- 9.5[- 16.2至- 2.9]）引起的每月急性医院接触率的大幅降低相关。对于养老院居民来说，由于特殊感染诊断、高钠血症、谵妄或意识不清（- 0.8[- 1.7至- 0.4]）和急性救护车运送（- 2.1[- 3.7至- 0.4]）引起的急性医院接触率每月下降。在80岁及以上的人群中，急诊救护车运送次数每月减少（- 3.8[- 6.6至- 0.9]）。解释：该框架显示了最小化部门间过渡的潜力，特别是在由特定感染诊断、高钠血症、谵妄或精神错乱引起的急性救护车运输和急性医院接触的背景下。这些发现可以为政策制定者对城市急性护理的作用提供有价值的见解。根据急性医院接触者的说法，一部分数字可能超出了该框架可以预防的范围，因此将重点放在特定群体上是有价值的。FundingØstifterne，丹麦南部地区，欧登塞大学医院和欧登塞市。

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Potential interactions of community-based acute care teams on the frequency of acute contacts with health-care systems: an interrupted time series analysis

Background

Ageing populations necessitate innovative approaches to health-care services. In 2018, Denmark introduced statutory municipal acute nursing care as part of community-based health care to improve care for adults with complex health needs. We evaluated the potential interactions of the acute care team Odense (ATO) on (1) acute hospital contacts; (2) acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion; and (3) acute ambulance transports.

Methods

In this retrospective, population-based, longitudinal study, we employed interrupted time series analysis to evaluate the association of ATO on adults in Odense Municipality from Jan 1, 2015, to Feb 28, 2019. Subgroup analyses were used to examine the data of people aged 80 years or older, nursing home residents, and people living at home with home or nursing care.

Findings

The people treated by ATO were older, had more comorbidities, and were more dependent on municipal health care than the average population. The implementation of ATO was not statistically significantly associated with the monthly rate of acute hospital contacts but associated with a substantial reduction of the monthly rates of acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion (−2·8 [95% CI −5·5 to −0·1]), and acute ambulance transports (−9·5 [−16·2 to −2·9]). For nursing home residents, the monthly rates decreased for acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion (−0·8 [−1·7 to 0·0]), and acute ambulance transports (−2·1 [−3·7 to −0·4]). Among those aged 80 years or older, acute ambulance transports decreased monthly (−3·8 [−6·6 to −0·9]).

Interpretation

This framework shows potential in minimising transitions between sectors, particularly in the context of acute ambulance transports and acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion. These findings could offer valuable insights for policy makers on the role of municipal acute nursing care. According to acute hospital contacts, a proportion of numbers might fall beyond the scope of what this framework can prevent, making it valuable to focus on specific groups.

Funding

Østifterne, Region of Southern Denmark, Odense University Hospital, and Odense Municipality.

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来源期刊

Lancet Healthy Longevity GERIATRICS & GERONTOLOGY-

CiteScore

16.30

自引率

2.30%

发文量

192

审稿时长

12 weeks

期刊介绍： The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.