Association between Timing of Clinical Evaluation by a Physician or Advanced Practitioner and Risk of Rehospitalization in Older Adults Admitted to a Skilled Nursing Facility Following Hospitalization: A Cohort Study.
Association between Timing of Clinical Evaluation by a Physician or Advanced Practitioner and Risk of Rehospitalization in Older Adults Admitted to a Skilled Nursing Facility Following Hospitalization: A Cohort Study.
复制标题
医生或高级执业医师进行临床评估的时机与住院后进入熟练护理机构的老年人再住院风险之间的关联：一项队列研究。
DOI：
10.1016/j.jamda.2023.09.004
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发表时间：
2023
影响因子：
7.6
通讯作者：
Burke,RobertE
中科院分区：
文献类型：
--
作者：
Ryskina,KiraL;Geng,Zhi;Raghavan,Sridharan;Waddell,KimberlyJ;Burke,RobertE
目的如何向在熟练护理机构(SNF)接受急性后护理的患者提供过渡性护理服务还不是很清楚。我们的目的是在全国老年队列中确定入院后医生或高级实践提供者(APP)就诊的时间与再住院风险的关联。设计回顾队列研究。设定和参与对象2,482,616名年龄在≥66岁的医疗保险服务费用受益者，他们在住院后进入SNF接受急性后护理。方法我们测量入院后14天内再次住院的相对风险作为第一次PAP就诊时间的函数，使用随访时间作为时间依赖的协变量，根据患者的人口统计学和临床特征进行调整。我们还评估了结果是否延伸到入院时预后不同的患者组。结果与入院后较晚出现的患者(≥2天)相比，入院较早的患者(0-1天)再住院的可能性较小。不同风险组之间的相对差异是相似的。结论和意义在SNF入院后由医生或APP进行及时评估可能防止再次住院。对劳动力的投资，如培训计划、实践创新，以及出院后对SNF就诊的公平补偿，可能会缓解因COVID大流行而加剧的劳动力短缺。
ObjectivesHow transitional care services are provided to patients receiving post-acute care in skilled nursing facilities (SNFs) is not well understood. We aimed to determine the association of timing of physician or advanced practice provider (APP) visit after SNF admission with rehospitalization risk in a national cohort of older adults.DesignRetrospective cohort study.Setting and Participants2,482,616 Medicare fee-for-service beneficiaries aged ≥66 years who entered an SNF for post-acute care following hospitalization.MethodsWe measured the relative risk of being rehospitalized within 14 days of SNF admission as a function of time to the first PAP visit, using time to follow-up as a time-dependent covariate, adjusted for patient demographics and clinical characteristics. We also evaluated whether findings extended across groups with different SNF prognosis on admission.ResultsPatients seen sooner after admission to an SNF (0-1 days) were less likely to be rehospitalized compared to patients seen later (≥2 days). The relative difference was similar across different risk groups.Conclusions and ImplicationsTimely evaluation by a physician or APP after SNF admission may protect against rehospitalization. Investment in the workforce such as training programs, practice innovations, and equitable reimbursement for SNF visits after hospital discharge may mitigate labor shortages that were exacerbated by the COVID pandemic.