How much is postacute care use affected by its availability?
How much is postacute care use affected by its availability?
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DOI：
10.1111/j.1475-6773.2005.0i366.x
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发表时间：
2005-04-01
影响因子：
3.4
通讯作者：
Escarce, JJ
中科院分区：
文献类型：
--
作者：
Buntin, MB;Garten, AD;Escarce, JJ
评估临床因素与非临床因素的相对影响，如急性期后护理（PAC）供应，以确定患者从急性护理出院后是否接受专业护理机构（SNF）或住院康复机构（IRF）的护理。医疗保险急性医院，IRF和SNF索赔提供了PAC选择的数据; PAC选择部位的预测因子来自医疗保险索赔、服务提供者、登记文件和地区资源文件数据。我们使用多项logit模型预测老年患者因中风住院后使用PAC，髋部骨折或下肢关节置换。构建了一个文件，链接了1999年住院的所有医疗保险患者的急性和急性后使用数据。在我们的许多模型中，PAC可用性是PAC使用的更有力的预测因素，而不是临床特征。在IRF和SNF护理之间的选择中，与提供者的距离和提供者的供应的影响特别明显。最近的IRF越远，最近的SNF越近，患者去IRF的可能性就越小。类似地，患者所在区域的IRF越少，SNF越多，患者去IRF的可能性就越小。此外，如果患者出院的医院有相关的IRF或相关的SNF，患者更有可能去there.We发现，PAC的可用性是一个主要的决定因素，患者是否使用这样的护理和他们使用哪种类型的PAC设施。需要进一步的研究，以评估这些研究结果是否表明，更多的PAC供应导致机构护理的使用率更高和更好的结果，或者它是否会导致不必要的资源支出和患者返回家园的延迟。
To assess the relative impact of clinical factors versus nonclinical factors-such as postacute care (PAC) supply-in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care.Medicare acute hospital, IRF, and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data.We used multinomial logit models to predict PAC use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements.A file was constructed linking acute and postacute utilization data for all medicare patients hospitalized in 1999.PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there.We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes-or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes.