Xianggang lao nian shuai ruo zhao hu dan wei de hu li mo shi dui zhang zhe lin chuang jie guo de cheng xiao: zhun shi yan yan jiu

D.Nurs.Background: Population aging increases the healthcare service demand, Hospital Authority (HA) required to face the challenge on managing the growing demand and ensure service safety and quality. Existing care model based on episodic disease model does not adequately respond to patients’ health needs. There is an urgent need to devise an effective strategy to proactively identify frail geriatric patients and provide coordinated and timely care through a person-centred model of care. The aim of this study is to evaluate the effects of the service model on the clinical outcomes among frail elderly patients in an acute hospital in Hong Kong.Methods: To address the service gap and take reference to other possible measures, the Frailty Unit would be proposed to set up at Emergency Medicine Ward (EMW) and run by senior Emergency Department doctor and senior nurses with experienced in care of elderly. A 12-month quasi-experimental study was conducted to examine the effectiveness of the newly set up Frailty Unit on patient’s outcomes. A 6-bed unit set up in an EMW in an acute hospital setting. The unit offers 24-hour service. The team involves multi-disciplinary health care professional. A care pathway is established to guide the care planning and co-ordination during the whole patient journey during their stay in Frailty Unit and achieve a safe discharge. The unplanned readmission within 30 days & 90 days were captured to evaluate the effectiveness of the study. Patients’ demographic and Quality of life concerns (mQOLC_E) were collected to examine the effect of Frailty Unit on patient’s outcomes.Results: The effect of intervention on unplanned readmission rate was assessed by logistic regression. There was no significant difference in the prevalence of having unplanned readmission to QEH at 30-day (p=0.68) and 90-day (p=0.54) after discharge but there was significant difference in the prevalence of having unplanned re-attendance to A&E at 30-day (p=0.02) and 90-day (p=0.02) post discharge between the intervention and control groups. Intervention group was 79% and 75% lower at risk of having unplanned re-attendance to A&E at 30-day and 90-day follow up respectively than control group.The generalized estimating equation (GEE) model was used to examine the differences in change of outcomes between control and interventional groups across time points (Baseline, 30 days &90 days after discharge). There was no significant difference in frailty scale (p = 0.75 and p = 0.83 at 30 days and 90 days respectively) in the intervention group when compare with control group. The mean MBI score for intervention group at 30 days & 90 days were 81.25 and 81.73 respectively. There were significant difference between control and intervention group at 30 days (p=0.02)& 90 days (p=0.00). For mQOLC-E, interventions were effective in improving the overall outcomes in study group over 30 days and 90 days (p < 0.001 and p < 0.001 at T1 and T2 respectively). The intervention showed an increase in single item (p = 0.003 and p = 0.0014 at T1 and T2 respectively), six domains (negative emotions: p = 0.008 and p = 0.0012 at T1 and T2 respectively, physical discomfort; p < 0.001 and p < 0.001 at T1 and T2 respectively, value of life: p = 0.002 and p = 0.002 at T1 and T2 respectively, existential distress: p = 0.004 and p < 0.001 at T1 and T2 respectively, care and support: p < 0.001 and p < 0.001 at T1 and T2 respectively and food-related concerns: p < 0.001 and p < 0.001 at T1 and T2 respectively).Conclusion: Older persons who are frail are more susceptible to dramatic health deterioration even with minor stressor due to the impaired homeostatic mechanism. They are at risk for adverse outcomes when admitted to hospital. Early identification of frail elderly and implement coordinate care using the care pathway can eensure elderly patients being treated promptly at effective and efficient manner. Transforming existing emergency services for frail elderly can benefit the patient experience and better utilize of the hospital resources. The Frailty Care Unit moves toward a more effective coordination on the needs of elderly patients who attending the emergency service in acute hospital. It also aligns with the corporate direction and policy. The care model can help to cope with the increasing healthcare demand of aging population and relieve the pressure on emergency service and hospital beds. In addition, it improves patient and caregiver experience through manage patient at right level of care at right place and time.背景：香港醫院管理局（醫管局）面對人口老化對醫療服務的需求日益增長，同時需要確保服務安全及質素方面的挑戰。用固有的護理模式並不能充分應付年長患者的健康需求。我們迫切需要製訂一套有效的模式，主動識別年老患者的需要，促進及協調以人為本的護理模式提供適時的護理。本研究的目的是評估年老衰弱照護單位對香港急症醫院年老患者臨床成效的影響。方法：為了解決服務差距並參考可行的措施，急症科病房成立了年老衰弱照護單位(FrailtyCareUnit)，由急症科高級醫生和擁有豐富長者護理經驗的護理人員負責照料。進行了為期12個月的準實驗研究，以檢測新成立的年老衰弱照護單位對年長患者臨床成效的影響。年老衰弱照護單位設置了六張病床並提供24小時服務。跨專業的醫療團隊跟從訂定的臨床路徑，協調周全性的老年評估並配合個人化的照顧計劃及出院安排。以30天和90天內再入院率評估研究的成效。同時，收集患者的功能狀態（MBI）和長者生存質量（mQOLC_E），以檢測年老衰弱照護單位單元對患者臨床成效的影響。結果：通過邏輯回歸進行評估研究組對非計劃再住院率的影響，在出院後第30天（p=0.68）和第90天（p=0.54），非計劃再入院率沒有顯著差異。但於出院後第三十天及第九十天內再往急症室求診的比率則存在顯著差異（p=0.02）。與對照組相比，研究組在第30天和90天再入院的風險分別降低了79％和75％。使用廣義估計方程式（GEE）模型來檢查對照組和研究組在不同時間點（基線，出院後30天和90天）結果變化的差異。與對照組相比，研究組的衰弱程度（分別為30天和90天，p=0.75和p=0.83）無顯著差異。研究組在30天和90天時的平均MBI評分分別為81.25和81.73。對照組和研究組在30天（p=0.02）和90天（p=0.00）之間有顯著差異。對於生存質量的比較，研究組在30天和90天內顯示總體評分均有所提升（分別在T1和T2時p<0.001和p<0.001）。同時，分類評分亦有所增加（分別為T1和T2分別為p=0.003和p=0.0014），六個分類中（負面情緒：T1和T2分別為p=0.008和p=0.0012，身體不適：T1和T2分別為p<0.001和p<0.001，生存價值：T1和T2分別為p=0.002和p=0.002，存在困擾分別為：T1和T2分別為p=0.004及p<0.001，醫護關注：T1和T2分別為p<0.001和p<0.001，飲食問題：在T1和T2分別為p <0.001和p