Functional Impairment and Postacute Care Discharge Setting May Be Useful for Stroke Survival Prognostication.
Functional Impairment and Postacute Care Discharge Setting May Be Useful for Stroke Survival Prognostication.
复制标题
DOI：
10.1161/jaha.121.024327
复制
发表时间：
2022-03-15
影响因子：
5.4
通讯作者：
Burke, James F.
中科院分区：
文献类型：
--
作者：
Springer, Mellanie, V;Skolarus, Lesli E.;Feng, Chunyang;Burke, James F.
本研究旨在讨论与卒中后功能和急性期后护理出院设置相关的卒中后结局，并告知患者提供者。我们对2013年患有急性缺血性卒中或脑出血的医疗保险受益人进行了一项回顾性队列研究。我们的主要结局是出院后至少1年内的死亡率。我们进行了多变量logistic回归以估计90天比值比（OR），并进行了考克斯比例风险回归以估计90天后死亡率的风险比，调整了人口统计学、手术、合并症、出院环境（住院康复机构、专业护理机构或家庭医疗保健机构）、卒中后功能（通过功能/假功能独立性测量）和环境-功能相互作用。共有167 000例患者，平均随访441天。90天内的死亡率与中风后功能（OR，0.23; 95%CI，0.19-0.27，比较中风后功能的最高和最低五分位数）和出院环境（OR，4.05;熟练护理机构与住院康复机构的95%CI，3.78-4.33）相关。在功能最高的患者中，出院到住院康复机构的患者1年死亡率为9%，出院后在家健康的患者1年死亡率为11%。出院至专业护理机构的功能最差的卒中幸存者1年死亡率为64%，出院至住院康复机构的患者1年死亡率为29.6%。近三分之二的功能最低的中风幸存者出院到一个熟练的护理设施在一年内死亡。这一发现应告知提供者和患者/护理人员之间的讨论，以调整护理目标与中风幸存者接受的护理。
The aim of this study was to discussions about post‐stroke outcomes related to post‐stroke function and post‐acute care discharge setting.inform patient‐provider. We conducted a retrospective cohort study of Medicare beneficiaries with acute ischemic stroke or intracerebral hemorrhage in 2013. Our primary outcome was mortality within at least 1‐year post discharge. We performed multivariate logistic regression to estimate 90‐day odds ratios (ORs) and Cox proportional hazards regression to estimate post 90‐day hazard ratios on mortality, adjusting for demographics, procedures, comorbidities, discharge setting (inpatient rehabilitation facility, skilled nursing facility, or home health care agency), post‐stroke function (measured by the Functional/Pseudo‐Functional Independence Measure) and setting‐function interactions. There were 167 000 patients with a mean follow‐up of 441 days. Mortality within 90 days was associated with post‐stroke function (OR, 0.23; 95% CI, 0.19–0.27 comparing highest to lowest quintile of post‐stroke function) and discharge setting (OR, 4.05; 95% CI, 3.78–4.33 for skilled nursing facility versus inpatient rehabilitation facility). Among the highest functioning patients, those discharged to inpatient rehabilitation facility had a 1‐year mortality of 9% and those discharged with home health had 11% mortality at 1 year. The lowest functioning survivors of stroke discharged to a skilled nursing facility had 64% mortality at 1 year and those discharged to an inpatient rehabilitation facility had 29.6% mortality at 1 year. Nearly two thirds of the lowest functioning survivors of stroke discharged to a skilled nursing facility die within a year. This finding should inform discussions between providers and patients/caregivers in aligning goals of care with the care survivors of stroke receive.