Frailty and Time at Home After Post-Acute Care in Skilled Nursing Facilities.
Frailty and Time at Home After Post-Acute Care in Skilled Nursing Facilities.
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在熟练护理机构进行急性后期护理后的虚弱和在家时间。
DOI：
10.1016/j.jamda.2023.02.106
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发表时间：
2023
影响因子：
7.6
通讯作者：
Kim,DaeH
中科院分区：
文献类型：
--
作者：
Shi,SandraM;Olivieri-Mui,Brianne;Oh,Gahee;McCarthy,Ellen;Bean,JonathanF;Kim,DaeH
研究目的：研究基于索赔的虚弱指数与在家时间的关系，定义为存活天数和在医院或专业护理机构（SNF）外度过的天数。设计队列研究。设置和患者：一个5%的医疗保险随机样本的收费服务受益人，谁有连续的部分A和B登记在前6个月，2014年至2016年从短期SNF入院出院的患者。方法采用经验证的基于索赔的虚弱指数（CFI）测量虚弱程度。（范围：0 - 1，分数越高表明虚弱越严重），并归类为非虚弱CFI <0.25）、轻度虚弱（CFI 0.25 ~ 0.34）和中重度虚弱（CFI ≥0.35）。我们测量了SNF出院后6个月内的在家时间（范围：0 - 182天，数值越高表示在家的天数越多，因此结局越好）。我们使用逻辑回归来评估虚弱和在家时间短（定义为<173天）之间的关联，调整年龄，性别，种族，地区，合并症指数，最小数据集中的临床SNF入院特征和SNF特征。（平均年龄，80.8岁，64.9%女性，85.9%白色），平均CFI为0.26（标准差，0.07）。平均居家时间：非虚弱组165.6（38.1）d，轻度虚弱组154.4（47.4）d，中重度虚弱组145.0（52.0）d。全模型调整后，中度至重度虚弱与1.71（95%CI 1.65 - 1.78）更高的几率有短的时间在家里在6个月后SNF discharge.Conclusion and ImplicationsHigher CFI与短的时间在家里的医疗保险受益人出院后急性SNF停留在社区。我们的研究结果支持CFI在识别需要额外资源和干预措施以防止健康下降和生活质量差的SNF患者方面的实用性。
ObjectivesTo examine the association of a claims-based frailty index with time at home, defined as the number of days alive and spent out of hospital or skilled nursing facility (SNF).DesignCohort Study.Setting and ParticipantsA 5% Medicare random sample of fee-for-service beneficiaries, who had continuous part A and B enrollment in the prior 6 months, that were discharged from a short SNF admission in 2014‒2016.MethodsFrailty was measured with a validated claims-based frailty index (CFI) (range: 0‒1, higher scores indicating worse frailty) and categorized into nonfrail (CFI <0.25), mild frailty (CFI 0.25‒0.34), and moderate-to-severe frailty (CFI ≥0.35). We measured home time in the 6 months following SNF discharge (range: 0‒182 days with higher values representing more days at home and thus a better outcome). We used logistic regression to assess the association between frailty and short home time, defined as <173 days, adjusting for age, sex, race, region, a comorbidity index, clinical SNF admission characteristics in the Minimum Data Set, and SNF characteristics.ResultsIn our sample of 144,708 beneficiaries (mean age, 80.8 years, 64.9% female, 85.9% white) who were discharged to community after SNF stay, the mean CFI was 0.26 (standard deviation, 0.07). The mean home time was 165.6 (38.1) days in nonfrail, 154.4 (47.4) days in mild frailty, 145.0 (52.0) days in moderate-to-severe frailty group. After full model adjustments, moderate to severe frailty was associated with a 1.71 (95% CI 1.65‒1.78) higher odds of having short time at home in the 6 months following SNF discharge.Conclusion and ImplicationsHigher CFI is associated with short time at home in Medicare beneficiaries who are discharged to the community after post-acute SNF stay. Our results support the utility of CFI in identifying SNF patients who need additional resources and interventions to prevent health decline and poor quality of life.