Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission
Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission
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DOI：
10.2522/ptj.20140610
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发表时间：
2015-12-01
期刊：
影响因子：
3.2
通讯作者：
Freburger, Janet K.
中科院分区：
文献类型：
--
作者：
Andrews, A. Williams;Li, Dongmei;Freburger, Janet K.
背景资料。康复治疗在急诊护理环境中的应用及其对再入院患者的影响，我们知之甚少。这项研究的目的是检查中风急性护理期间接受康复服务的强度与30天和90天再次住院的风险之间的关系。对阿肯色州和佛罗里达州的所有急性护理医院进行了回顾性队列分析。纳入患者(N=64,065)，他们在2009年或2010年因突发中风入院。康复强度根据各医院物理治疗、作业治疗、言语治疗费用的总和及分布情况分为无、低、中-低、中-高、高。用COX比例风险回归估计危险比，控制人口学特征、疾病严重程度、合并症、医院变量和状态。与接受低强度治疗的参与者相比，接受高强度治疗的参与者再次住院30天的风险降低。高强度组的风险最低(危险比=0.86；95%可信区间=0.79，0.93)。与接受低强度治疗的患者相比，未接受治疗的患者再次住院的风险更高(风险比=1.30；95%可信区间=1.22，1.40)。对于90天的再次入院，研究结果相似，但影响较小。此外，与接受低强度治疗的患者相比，接受高强度治疗的患者有更多的并发症和更严重的疾病。这项研究的结果在范围和推广性方面都是有限的。此外，这项研究可能没有充分考虑到所有潜在的重要协变量。在中风的急性护理中接受康复治疗和加强康复治疗与降低再次入院的风险有关。
Background. Little is known about the use of rehabilitation in the acute care setting and its impact on hospital readmissions.Objective. The objective of this study was to examine the association between the intensity of rehabilitation services received during the acute care stay for stroke and the risk of 30-day and 90-day hospital readmission.Design. A retrospective cohort analysis of all acute care hospitals in Arkansas and Florida was conducted.Methods. Patients (N=64,065) who were admitted foran incident stroke in 2009 or 2010 were included. Rehabilitation intensity was categorized as none, low, medium-low, medium-high, or high based on the sum and distribution of physical therapy, occupational therapy, and speech therapy charges within each hospital. Cox proportional hazards regression was used to estimate hazard ratios, controlling for demographic characteristics, illness severity, comorbidities, hospital variables, and state.Results. Relative to participants who received the lowest intensity therapy, those who received higher-intensity therapy had a decreased risk of 30-day readmission. The risk was lowest for the highest-intensity group (hazard ratio =0.86; 95% confidence interval=0.79, 0.93). Individuals who received no therapy were at an increased risk of hospital readmission relative to those who received low-intensity therapy (hazard ratio=1.30; 95% confidence interval=1.22, 1.40). The findings were similar, but with smaller effects, for 90-day readmission. Furthermore, patients who received higher-intensity therapy had more comorbidities and greater illness severity relative to those who received lower-intensity therapy.Limitations. The results of the study are limited in scope and generalizability. Also, the study may not have adequately accounted for all potentially important covariates.Conclusions. Receipt of and intensity of rehabilitation therapy in the acute care of stroke is associated with a decreased risk of hospital readmission.