Study on a multidisciplinary continuing management model for hospitalized elderly patients with multimorbidity / 中华老年医学杂志

ABSTRACT

Objective:To construct a multidisciplinary continuing management model for hospitalized elderly patients with multimorbidity and to assess the effectiveness of this model, thus providing insights and suggestions for the management of elderly patients with co-morbidity.Methods:This was a prospective randomized controlled study.Patients with comorbidity admitted to the geriatric ward of our hospital from November 2015 to July 2017 were selected and received comprehensive geriatric assessment(CGA). Patients were randomly divided into the intervention group receiving continuous multidisciplinary medical treatment and the control group receiving conventional medical treatment.The work flow and characteristics of the intervention group were examined, and the effectiveness of the two models(including cost of hospitalization, duration, patient satisfaction, patient functional status, adverse events, and changes in healthy behavior awareness after 6 months of follow-up)were compared between the two groups.Results:A total of 440 patients with comorbidity were included in the study, with an average age of(76.0±8.1)years, including 226 in the intervention group and 214 in the control group.After multidisciplinary continuing medical intervention, patients in the intervention group were associated with a significantly higher level of satisfaction on physician availability(86.3% vs.74.8%, χ2=9.354, P=0.002), medical care(99.6%vs.86.7%, χ2=4.926, P=0.026)and nursing quality(93.4%vs.86.4%, χ2=5.829, P=0.016), compared with the control group.After 6 months of follow-up, the probability of adverse events in the intervention group was lower than that in the control group(61.1%vs.73.5%, χ2=7.436, P=0.006), and drug-related adverse reactions/events in the intervention group(9.0%vs.22.1%, χ2=13.858, P<0.000)were significantly lower than those in the control group.Furthermore, the proportion of patients with improved healthy behavior awareness was markedly higher in the intervention group than that in the control group(30.3%vs.5.4%, χ2=43.979, P<0.001). Conclusions:The multidisciplinary hospital-community continuity management model with CGA at the core can reduce the occurrence of adverse events, improve patient satisfaction and healthy behavior awareness, and is a worthy exploration of a new medical model for elderly comorbid patients.