Impact of a Videoconference Educational Intervention on Physical Restraint and Antipsychotic Use in Nursing Homes: Results From the ECHO-AGE Pilot Study

被引：30

作者：

Gordon, Stephen E. ^{[1
,2
,3
]}

Dufour, Alyssa B. ^{[1
,3
,4
]}

Monti, Sara M. ^{[1
]}

Mattison, Melissa L. P. ^{[1
,3
]}

Catic, Angela G. ^{[1
]}

Thomas, Cindy P. ^{[5
]}

Lipsitz, Lewis A. ^{[1
,3
,4
]}

机构：

[1] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[2] Hebrew SeniorLife, Roslindale, MA USA

[3] Harvard Univ, Sch Med, Boston, MA USA

[4] Hebrew SeniorLife, Inst Aging Res, Roslindale, MA USA

[5] Brandeis Univ, Schneider Inst Hlth Policy, Waltham, MA USA

来源：

JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION | 2016年 / 17卷 / 06期

关键词：

Dementia; nursing home; antipsychotics; physical restraints; videoconferencing; HEPATITIS-C; DEMENTIA; SYMPTOMS; LONG; CARE; MEDICATIONS; RESIDENTS; KNOWLEDGE; QUALITY; RISK;

D O I：

10.1016/j.jamda.2016.03.002

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Objectives: US nursing homes care for increasing numbers of residents with dementia and associated behavioral problems. They often lack access to specialized clinical expertise relevant to managing these problems. Project ECHO-AGE provides this expertise through videoconference sessions between frontline nursing home staff and clinical experts at an academic medical center. We hypothesized that ECHO-AGE would result in less use of physical and chemical restraints and other quality improvements in participating facilities. Design: A 2: 1 matched-cohort study comparing quality of care outcomes between ECHO-AGE facilities and matched controls for the period July 2012 to December 2013. Setting: Eleven nursing homes in Massachusetts and Maine. Participants: Nursing home staff and a hospital-based team of geriatrician, geropsychiatrist, and neurologist discussed anonymized residents with dementia. Intervention: Biweekly online video case discussions and brief didactic sessions focused on the management of dementia and behavior disorders. Measurements: The primary outcome variables were percentage of residents receiving antipsychotic medications and the percentage of residents who were physically restrained. Secondary outcomes included 9 other quality of care metrics from MDS 3.0. Results: Residents in ECHO-AGE facilities were 75% less likely to be physically restrained compared with residents in control facilities over the 18-month intervention period (OR = 0.25, P =.05). Residents in ECHO-AGE facilities were 17% less likely to be prescribed antipsychotic medication compared with residents in control facilities (OR = 0.83, P =.07). Other outcomes were not significantly different. Conclusion: Preliminary evidence suggests that participation in Project ECHO-AGE reduces rates of physical restraint use and may reduce rates of antipsychotic use among long-term nursing home residents. (c) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

引用

页码：553 / 556

页数：4