三级医院（YASAM）的社区综合健康老龄化计划可能有减少急诊入院的潜力：来自干预前-后研究的初步证据

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-05-01 DOI:10.1016/j.jemermed.2024.12.009

Bilal Katipoglu M.D. , Suleyman Emre Kocyigit M.D. , Ugur Ergun M.D. , Abdullah Osman Kocak M.D. , Ozkan Aydeniz M.D. , Ismail Mert M.D. , Serkan Kadir Keskin MD.

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引用次数: 0

摘要

背景：居住在社区的年老体弱的老年人在试图进入门诊诊所时经常面临障碍，这导致他们对急诊科的依赖程度更高。这一趋势突出表明，需要改善对这一弱势群体的可及性和支助服务。目的探讨三级医院社区健康养老综合服务与老年人医疗保健利用的关系。方法于2023年6月至2023年12月进行前瞻性试验干预前后对照研究。YASAM进行了全面的评估，包括Mini- cog、Mini精神状态评估、Mini营养评估（简短形式）和老年抑郁症（Yesavage）量表，以及Time-up和Go测试和Stand-Chair测试。在索引日期之后和之前记录了参与者的医疗服务利用情况，包括急诊、住院和门诊就诊。结果共纳入312例患者，平均年龄85.8±3.9岁。轻度认知障碍患者占55.8% （n = 159）。可能患有肌肉减少症的参与者比例为43.3% (n = 135)，中度或重度虚弱的参与者比例为53.8% （n = 163）。指标日期前急诊月平均就诊次数低于指标日期后，差异有统计学意义（p = 0.01）。结论决策者应考虑在三级医院扩大以社区为基础的健康老龄化综合项目，以满足老年人日益增长的医疗保健需求。试验注册该试验在ClinicalTrials.gov上进行了前瞻性注册。标识符：NCT05993572注册于2023年7月15日。

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A Community-Based Integrated Healthy Aging Program at a Tertiary Hospital (YASAM) for the Oldest Old Participants May have the Potential to Reduce Emergency Admission: Preliminary Evidence from a Pre–Post-Intervention Study

Background

Frail, oldest old individuals living in the community frequently face obstacles when trying to access outpatient clinics, which results in a higher dependence on emergency departments. This trend highlights the need for improved accessibility and support services for this vulnerable population.

Objectives

This study aims to investigate the relationship between community-based integrated healthy aging program in tertiary hospital and healthcare utilization among the oldest old adults.

Methods

A before-after pilot intervention prospective study was conducted between June 2023 and December 2023. The YASAM conducted a comprehensive assessment, including the Mini-Cog, Mini Mental Status Assessment, Mini Nutrition Assessment (short form), and Geriatric Depression (Yesavage) scale, as well as the Time-up and Go test and Stand-Chair tests. Health service utilization, including emergency visits, hospitalizations, and outpatient clinic visits, was documented after and before the index date for the participants.

Results

The study included 312 participants, with a mean age of 85.8 ± 3.9 years. The proportion of individuals with mild cognitive impairment was 55.8 % (n = 159). The percentage of participants with possible sarcopenia was 43.3 % (n = 135), and the percentage of those with moderate or severe frailty was 53.8 % (n = 163). The average visits to the emergency department per month before the index date were lower than after the index date, and this difference was significant (p = 0.01).

Conclusions

Policymakers should consider expanding community-based integrated healthy aging programs in tertiary hospitals to meet the growing healthcare needs of older adults.

Trial registration

The trial was prospectively registered at ClinicalTrials.gov. Identifier: NCT05993572 Registered on 15 July 2023.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine