Hospital Readmission Among Older Adults Who Return Home With Unmet Need for ADL Disability
Hospital Readmission Among Older Adults Who Return Home With Unmet Need for ADL Disability
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DOI：
10.1093/geront/gns103
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发表时间：
2013-06-01
期刊：
影响因子：
5.7
通讯作者：
Sands, Laura P.
中科院分区：
文献类型：
--
作者：
DePalma, Glen;Xu, Huiping;Sands, Laura P.
目的：本研究确定了近期因日常生活活动（ADL）需求未得到满足而住院后返回社区是否与再入院概率相关。研究方法：共有584名受访者1994年，1999年和/或2004年国家长期护理调查（NLTCS）谁住院前90天内的采访和报告ADL残疾的采访时，被认为是分析。与NLTCS相关的医疗保险索赔提供了有关医院事件的信息，因此不包括在健康维护组织或退伍军人事务医疗中心登记的患者（n = 62），导致总样本量为522。ADL残疾被定义为需要人的帮助或设备来完成任务。未满足的ADL需求被定义为一种或多种ADL残疾获得的帮助不足或没有获得帮助。在面试后90天内开始的残疾被认为是新的残疾。结果如下：在调整人口统计学、健康和功能特征后，未满足的ADL需求与再入院风险增加相关（HR：1.37，95% CI：1.03-1.82）。新残疾需求未得到满足的患者的再入院风险高于指数住院前存在残疾需求未得到满足的患者（HR：1.66，95% CI：1.01-2.73）。提示：许多老年患者出院时存在ADL障碍。那些报告在出院回家后对新的ADL残疾的需求未得到满足的人特别容易再次入院。应仔细评估和解决患者出院后的功能需求。
Purpose: This study determined whether returning to the community from a recent hospitalization with unmetactivities of daily living (ADL) need was associated with probability of readmission. Methods: A total of 584 respondents to the 1994, 1999, and/or 2004 National Long-Term Care Surveys (NLTCS) who were hospitalized within 90 days prior to the interview and reported ADL disability at the time of the interview were considered for analysis. Medicare claims linked to the NLTCS provided information about hospital episodes, so those enrolled in Health Maintenance Organizations or Veterans Affairs Medical Centers were not included (n = 62), resulting in a total sample size of 522. ADL disability was defined as needing human help or equipment to complete the task. Unmet ADL need was defined as receiving inadequate or no help for one or more ADL disabilities. Disability that began within 90 days of the interview was considered new disability. Results: After adjusting for demographic, health, and functioning characteristics, unmet ADL need was associated with increased risk for hospital readmission (HR: 1.37, 95% CI: 1.03-1.82). Risk of readmission was greater for those with unmet need for new disabilities than those with unmet need for disabilities that were present before the index hospitalization (HR: 1.66, 95% CI: 1.01-2.73). Implications: Many older patients are discharged from the hospital with ADL disability. Those who report unmet need for new ADL disabilities after they return home from the hospital are particularly vulnerable to readmission. Patients' functional needs after discharge should be carefully evaluated and addressed.