A cluster randomized controlled trial (GOAL trial) evaluated a comprehensive geriatric assessment for frail older people with chronic kidney disease.

Our GOAL trial evaluated whether an outpatient CGA could improve patient-centered goal attainment in this population.

我们的GOAL试验评估了门诊CGA是否能在这一人群中改善以患者为中心的目标达成。

Methods

GOAL was an open-label, cluster-randomized controlled trialconducted across 15 Australian kidney outpatient centers from March 2021 to June 2023, with a 12-month follow-up.

GOAL是一项开放标签、群组随机对照试验，在2021年3月至2023年6月期间在澳大利亚的15个肾脏门诊中心进行，随访期为12个月。

Centers randomized 1:1, delivered a single outpatient CGA plus usual care or usual care alone.

中心按1:1随机分配，提供一次门诊CGA加常规护理或仅常规护理。

Participants were aged 65 years and older (55 years and older for First Nations peoples) with moderate to severe CKD (eGFR 59 mL/min per 1.73 m2 and under) and frail (Frailty Index over 0.25).

参与者年龄在65岁及以上（对于原住民人民为55岁及以上），患有中度至重度CKD（eGFR 59 mL/min per 1.73 m2及以下）且虚弱（虚弱指数超过0.25）。

Of 771 screened, 240 were enrolled (mean age 76.9 years; median Frailty Index 0.39; 56% male), and 179 (74.6%) completed follow-up.

在771名筛查对象中，有240名被纳入（平均年龄76.9岁；中位虚弱指数0.39；56%为男性），179名（74.6%）完成了随访。

In intervention centers, geriatricians performed a one-off CGA and provided individualized management plans.

在干预中心，老年病医生进行了一次性的CGA并提供了个性化的管理计划。

The primary outcome was goal attainment at three months, assessed using Goal Attainment Scaling (GAS), where a mean score of 50 or more indicates goal achievement.

主要结果是在三个月时的目标达成，使用目标达成量表（GAS）进行评估，平均得分50或以上表示目标达成。

Mixed-effects linear regression was used for analysis.

使用混合效应线性回归进行分析。

Secondary outcomes included quality of life, frailty status, mortality, hospitalizations, and residential aged care admission.

次要结果包括生活质量、虚弱状态、死亡率、住院情况以及老年护理院的入住情况。

All analyses were intention-to-treatat both cluster and participant levels.

所有分析均按照意向治疗原则在群组和参与者层面进行。

Results

At three months, mean GAS scores were not significantly different between the intervention and control groups (45.2 vs 43.7; mean difference 1.54, 95% confidence interval: 3.13 to 6.20).

在三个月时，干预组和对照组之间的平均GAS评分没有显著差异（分别为45.2和43.7；平均差异1.54，95%置信区间：3.13至6.20）。

No significant differences were found across secondary outcomes.

在次要结果方面未发现显著差异。

A non-statistically significant reduction of 2.5 days in total hospital stay was observed in the intervention group.

观察到干预组总住院天数减少了2.5天，但这一差异不具有统计学意义。

Conclusions

Outpatient CGA did not improve goal attainment or clinical outcomes in frail older adults with CKD.

门诊全面老年评估并未改善慢性肾脏病虚弱老年人的目标达成或临床结果。

These findings do not support routine implementation of single-episode outpatient CGA in this setting and suggest a need for alternative, integrated models of person-centered care.

这些发现不支持在此背景下常规实施单次门诊全面老年评估，并暗示需要其他综合的、以个人为中心的护理模式。

trial_registration

Registered at ClinicalTrials.gov with study number NCT04538157.

已在ClinicalTrials.gov注册，研究编号为NCT04538157。