Contemporary Trends and Predictors of Postacute Service Use and Routine Discharge Home After Stroke
Contemporary Trends and Predictors of Postacute Service Use and Routine Discharge Home After Stroke
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DOI：
10.1161/jaha.114.001038
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发表时间：
2015-02-01
影响因子：
5.4
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Bettger, Janet Prvu;McCoy, Lisa;Peterson, Eric D.
背景-出院后回家是医疗保健的主要目标；然而，为了使中风患者恢复到事件前的状态，额外的急性后护理(PAC)服务有时是必要的。方法和结果：我们检查了住院康复机构(IRF)、熟练护理机构(SNF)、家庭健康(HH)和无服务家庭(HH)的出院趋势，共有849 780名18岁的缺血性或出血性中风患者参加了GET-卒中指南。多变量分析被用来确定与出院到任何PAC(IRF、SNF或HH)和出院未接受服务的家庭相关的因素。从2003年到2011年，在中风住院后，PAC的使用增加了2.1%(未经调整的P=0.001)。变化最大的是固氮肥的使用，在此期间下降了8.3%。IRF和HH分别增长6.9%和3.6%。急性护理后使用PAC的两个最强临床预测因素是住院第二天不能行走的患者(OR[OR]，3.03；95%可信区间[CI]，2.86~3.23)和吞咽困难筛查失败或有限制口服的命令的患者(OR，2.48；95%CI，2.37~2.59)。尽管自2003年以来，PAC的总体使用几乎没有变化，但还需要进一步的研究来解释按类型划分的服务使用的变化及其对结果的影响。
Background-Returning home after the hospital is a primary aim for healthcare; however, additional postacute care (PAC) services are sometimes necessary for returning stroke patients to their pre-event status. Recent trends in hospital discharge disposition specifying PAC use have not been examined across age groups or health insurance types.Methods and Results-We examined trends in discharge to inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home with home health (HH), and home without services for 849 780 patients >= 18 years of age with ischemic or hemorrhagic stroke at 1687 hospitals participating in Get With The Guidelines-Stroke. Multivariable analysis was used to identify factors associated with discharge to any PAC (IRF, SNF, or HH) versus discharge home without services. From 2003 to 2011, there was a 2.1% increase (unadjusted P=0.001) in PAC use after a stroke hospitalization. Change was greatest in SNF use, an 8.3% decrease over the period. IRF and HH increased 6.9% and 3.6%, respectively. The 2 strongest clinical predictors of PAC use after acute care were patients not ambulating on the second day of their hospital stay (ambulation odds ratio [OR], 3.03; 95% confidence interval [CI], 2.86 to 3.23) and those who failed a dysphagia screen or had an order restricting oral intake (OR, 2.48; 95% CI, 2.37 to 2.59).Conclusions-Four in 10 stroke patients are discharged home without services. Although little has changed overall in PAC use since 2003, further research is needed to explain the shift in service use by type and its effect on outcomes.