Dissemination of the Hospital Elder Life Program: Implementation, adaptation, and successes

被引:139
作者
Inouye, Sharon K.
Baker, Dorothy I.
Fugal, Patricia
Bradley, Elizabeth H.
机构
[1] Hebrew SeniorLife, Aging Brain Ctr, Inst Aging Res, Boston, MA 02131 USA
[2] Harvard Univ, Sch Med, Dept Med, Beth Israel Deaconess Med Ctr, Boston, MA 02115 USA
[3] Yale Univ, Sch Med, Dept Med, New Haven, CT USA
[4] Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, New Haven, CT USA
关键词
Hospital Elder Life Program; delirium prevention; hospital care; geriatrics; geriatric assessment; acute care for the elderly; iatrogenesis;
D O I
10.1111/j.1532-5415.2006.00869.x
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: To describe the Hospital Elder Life Program (HELP) across dissemination sites, to detail adaptations, and to summarize advantages across sites. DESIGN: Cross-sectional survey. SETTING: HELP sites in acute care hospitals. PARTICIPANTS: Thirteen sites that enrolled 11,344 patients. MEASUREMENTS: Seventy-five closed- and open-ended questions describing details of the HELP site, procedures, staffing, outcomes tracked, and advantages. RESULTS: As of July 1, 2005, HELP had been fully implemented in 13 sites, with a median duration of 24 months (range 6.0-38.0). Although a high degree of fidelity to the original model was maintained, variations existed in staffing patterns, outcome tracking, and recommended HELP procedures. Adaptations were made across multiple domains, including enrollment criteria at 15.4% of sites, screening and assessment tools at 61.5%, and individual intervention protocols at 15.4% to 30.8%. Local circumstances drove these adaptations, with the most common reasons being lack of adequate staffing and logistical constraints. All sites conducted regular HELP staff meetings; other recommended quality assurance procedures were conducted at 46.2% to 92.3% of sites. Reported advantages of HELP included providing an educational resource at 100% of sites, improving hospital outcomes (e.g., delirium and functional decline) at 100%, providing nursing education and improving retention at 100%, enhancing patient and family satisfaction with care at 92.3%, raising visibility for geriatrics at 92.3%, and improving quality of care at 84.6%. CONCLUSION: This report describes the real-world implementation of HELP across 13 sites, documents their local adaptations and successes, and provides insight into how motivated institutions can create change to improve quality of care for older persons.
引用
收藏
页码:1492 / 1499
页数:8
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