RESUMO
The burden of diabetes is greater for minorities and medically underserved populations in the United States. An evidence-based provider-delivered diabetes self-management education intervention was implemented in a federally qualified health center for medically underserved adult patients with type 2 diabetes. The findings provide support for the efficacy of the intervention on improvement in self-management behaviors and glycemic control among underserved patients with diabetes, while not substantially changing provider visit time or workload.
Assuntos
Diabetes Mellitus Tipo 2/terapia , Melhoria de Qualidade , Autocuidado/psicologia , Populações Vulneráveis , Diabetes Mellitus Tipo 2/etnologia , Etnicidade , Feminino , Hemoglobinas Glicadas/análise , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Educação de Pacientes como Assunto/métodos , Pobreza , Inquéritos e Questionários , Estados UnidosRESUMO
AIM: To examine whether a hospitalist-directed interdisciplinary (ITD) team in an internal medicine residency program enhances the hospital and clinical outcomes for seniors with acute medical illness. METHODS: Seniors admitted to a USA teaching hospital medical floor-teaching services were allocated to the ITD (n = 379) and usual care teams (n = 383). Compared with the usual care team, the ITD team physicians carried out daily "geriatric" assessment and management, and led ITD team meetings. RESULTS: The mean probability of functional decline on hospital discharge in the ITD team (25%; 95% CI 19-30%) was significantly lower than that in the usual care team (36%; 95% CI 30-43%; OR 0.35; 95% CI 0.10-0.92; P < 0.001). The mean probability of delirium in the ITD team (26%; 95% CI 20-32%) was significantly lower than that in the usual care team (34%; 95% CI 28-41%; OR 0.48; 95% CI 0.16-0.97; P = 0.03). The mean probability of transition to an institution in the ITD team (18%; 95% CI 13-23%) was significantly lower than that in the usual care team (26%; 95% CI 19-32%; OR 0.41; 95% CI 0.14-0.95; P = 0.01). CONCLUSIONS: Hospitalist-directed ITD team care is associated with reductions of functional decline, delirium and transition to an institution for seniors with acute medical illness.
Assuntos
Doença Aguda/terapia , Delírio/prevenção & controle , Médicos Hospitalares , Hospitalização/estatística & dados numéricos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Transição para Assistência do Adulto/tendências , Idoso , Idoso de 80 Anos ou mais , Hospitais de Ensino , Humanos , Estados UnidosRESUMO
AIM: To examine whether an internal medicine interdisciplinary floor team enhances the hospital and clinical outcomes for seniors with acute medical illness. METHODS: Seniors admitted to medical floor teaching services of a USA teaching hospital were recruited and allocated to the interdisciplinary (ITD; n = 236) and usual care teams (n = 248). Compared with the usual care team, the interdisciplinary team physicians carried out daily "geriatric" assessment and management, and led the interdisciplinary team meeting designed for improving interprofessional collaboration. RESULTS: After controlling for patient and physician characteristics, the mean hospital length of stay in the ITD team (6.1 days; 95% CI 5.2-7.7 days) was 0.7 days shorter than that in the usual care team (6.8 days; 95% CI 5.7-8.3 days; P = 0.008). There was no significant difference in delirium and 30-day hospital readmission between care groups. CONCLUSIONS: Notwithstanding partly positive associations, the results from the present study suggest that interdisciplinary team-based care is, at best, associated with enhancing the clinical and hospital outcomes for seniors with acute medical illness.