Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services: The Relationship of Functional Status and Pain.
Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services: The Relationship of Functional Status and Pain.
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DOI：
10.1097/nhh.0000000000000830
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发表时间：
2020
影响因子：
--
通讯作者：
Mooney K
中科院分区：
文献类型：
--
作者：
Kang Y;Sheng X;Stehlik J;Mooney K
心力衰竭（HF）是美国再住院的主要原因之一。由于HF的复杂性，Medicare认证的家庭医疗保健服务的提供已经增加。Medicare认证的家庭医疗保健机构测量并向Medicare和Medicaid服务中心报告患者的结果，如功能状态，日常生活活动（ADL）和日常生活的工具活动。这些指标使用结果评估信息集（OASIS）进行评估。作为一个大型数据集，OASIS已被用于以多种方式提高护理质量，包括识别患者不良结局的风险因素。然而，缺乏OASIS分析来评估功能状态与其他因素（如疼痛）在阻碍HF患者住院后恢复方面的作用之间的关系。因此，本研究的目的是使用OASIS数据库确定功能状态与疼痛之间的关系。在489例接受家庭医疗的HF患者中，83%为白色，57%为女性，中位年龄为80岁。出院时报告每日但非持续活动干扰疼痛的患者表现出ADL测量的功能表现改善最少，而无活动干扰疼痛的患者表现出ADL表现改善最大（p值=0.0284）。跟踪个体患者ADL评分，特别是活动干扰疼痛的频率，可能是家庭医疗环境中HF患者临床关注的关键指标。
Heart failure (HF) is one of the leading causes of rehospitalization in the United States. Due to the complex nature of HF, the provision of Medicare-certified home healthcare services has increased. Medicare-certified home healthcare agencies measure and report patients’ outcomes such as functional status, activities of daily living (ADL) and instrumental activities of daily living to the Centers for Medicare and Medicaid Services. These metrics are assessed using the Outcome Assessment Information Set (OASIS). As a large data set, OASIS has been used to advance care quality in multiple ways including identifying risk factors for negative patient outcomes. However, there is a lack of OASIS analyses to assess the relationship between functional status and the role of other factors, such as pain, in impeding recovery after hospitalization among HF patients. Therefore, the purpose of this study is to identify the relationship between functional status and pain using the OASIS database. Among 489 HF patients admitted to home healthcare, 83% were White, 57% were female, and the median age was 80. Patients who reported daily but not constant activity-interfering pain at discharge demonstrated the least improvement in functional performance as measured by ADLs, while patients without activity-interfering pain demonstrated the greatest improvement in ADL performance (p-value=0.0284). Tracking individual patient ADL scores, particularly the frequency of activity-interfering pain, could be a key indicator for clinical focus for patients with HF in the home healthcare setting.