Disparities in post-acute rehabilitation care for joint replacement.
Disparities in post-acute rehabilitation care for joint replacement.
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DOI：
10.1002/acr.20477
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发表时间：
2011-07
影响因子：
4.7
通讯作者：
Edwards, Lloyd J.
中科院分区：
文献类型：
--
作者：
Freburger, Janet K.;Holmes, George M.;Ku, Li-Jung E.;Cutchin, Malcolm P.;Heatwole-Shank, Kendra;Edwards, Lloyd J.
确定在使用急性后康复护理 (PARC) 进行关节置换方面存在的人口和地理差异程度。对四个州（亚利桑那州、佛罗里达州、新泽西州、威斯康星州）392 家医院的两年（2005-2006 年）基于人群的出院数据进行横断面分析。共有 164,875 名 45 岁及以上的人入院接受髋关节或膝关节置换术，并在住院期间幸存下来。检查了三个二分因变量：1）出院回家与机构（即熟练护理机构（SNF）或住院康复机构（IRF））； 2) 出院回家，有或没有家庭健康 (HH)； 3) 放电至 SNF 与 IRF。进行多级逻辑回归分析，以确定 PARC 使用的人口和地理差异，控制疾病严重程度/合并症、医院特征和 PARC 供应。探讨了种族、社会经济和地理变量之间的相互作用。考虑到 PARC 是就每天康复时间而言从加强护理到宽松护理的连续体（例如，IRF→SNF→HH→无 HH），未参保者在所有三种模式中接受的重症护理都较少。在 HH/无 HH 和 SNF/IRF 模型中，享受医疗补助的个人和社会经济地位较低的个人接受的重症监护较少。生活在农村地区的个人在机构/家庭和家庭/非家庭模式中接受的重症监护较少。种族的影响因保险和国家而改变。在大多数情况下，少数族裔接受的重症监护较少。 PARC 的使用因医院而异。需要努力进一步了解这些差异背后的原因及其对结果的影响。
To determine the extent to which demographic and geographic disparities exist in the use of post-acute rehabilitation care (PARC) for joint replacement. Cross-sectional analysis of two years (2005–2006) of population-based hospital discharge data from 392 hospitals in four states (AZ, FL, NJ, WI). 164,875 individuals 45 years and older admitted to the hospital for a hip or knee joint replacement and who survived their inpatient stay were identified. Three dichotomous dependent variables were examined: 1) discharge to home vs. institution (i.e., skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF)); 2) discharge to home with vs. without home health (HH); and 3) discharge to a SNF vs. IRF. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use, controlling for illness severity/comorbidities, hospital characteristics, and PARC supply. Interactions among race, socioeconomic, and geographic variables were explored. Considering PARC as a continuum from more to less intensive care in regard to hours of rehabilitation/day (e.g., IRF→SNF→HH→no HH), the uninsured received less intensive care in all three models. Individuals on Medicaid and those of lower SES received less intensive care in the HH/no HH and SNF/IRF models. Individuals living in rural areas received less intensive care in the institution/home and HH/no HH models. The effect of race was modified by insurance and by state. In most instances minorities received less intensive care. PARC use varied by hospital. Efforts to further understand the reasons behind these disparities and their effect on outcomes are needed.
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影响因子：
3
作者：
Dall, Timothy M.;Chen, Yaozhu J.;Hogan, Paul F.
通讯作者：
Hogan, Paul F.
影响因子：
3.4
作者：
Buntin, MB;Garten, AD;Escarce, JJ
通讯作者：
Escarce, JJ
影响因子：
3.4
作者：
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Ettner, Susan L.
DOI：
10.1016/j.apmr.2007.05.030
发表时间：
2007-11-01
影响因子：
4.3
作者：
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通讯作者：
Heinemann, Allen W.
影响因子：
1.9
作者：
Larsen, K;Petersen, JH;Endahl, L
通讯作者：
Endahl, L