Transitions from home to nursing home in a capitated long-term care program: the role of individual support systems.
Transitions from home to nursing home in a capitated long-term care program: the role of individual support systems.
复制标题
在按人头计额的长期护理计划中从家庭到疗养院的过渡：个人支持系统的作用。
作者：
E. J. Bauer
客观的
本研究计算了在按人头计额的长期护理系统中接受家庭和社区 (HCB) 护理的客户入住疗养院的风险。
数据来源
1989 年 1 月至 1991 年 12 月期间在亚利桑那州长期护理系统 (ALTCS) 中获得 HCB 长期护理安置的非机构老年人和身体残疾 (EPD) 客户的计划管理数据。
研究设计
最初接受 HCB 护理的客户 (N = 2,923) 的计划经历从他们进入计划之日起一直到 1992 年 12 月末进行了跟踪。
数据提取方法
项目管理数据用于为每个客户创建不同的项目体验。然后使用 Cox 比例风险回归模型来评估研究期间与进入疗养院风险相关的个体因素。
主要发现
据观察，老年人或白人以及患有阿尔茨海默病的客户进入疗养院的风险最大。支持系统变量几乎没有观察到显着影响。
结论
研究结果表明，如果将重点放在对客户进行首次评估以安排进入 ALTCS 计划时，防止进入疗养院的努力可能会最有效。一旦进入 HCB 护理，后续安置疗养院的风险可能与客户的健康和虚弱程度相关，而不是与支持系统因素相关。
OBJECTIVE
This study calculated the risk of nursing home admission for clients receiving home- and community-based (HCB) care in a capitated long-term care system.
DATA SOURCES
Program administrative data for non-institutionalized elderly and physically disabled (EPD) clients who had an HCB long-term care placement in the Arizona Long-Term Care System (ALTCS) during the period from January 1989 through December 1991.
STUDY DESIGN
The program experience of clients who were initially placed in HCB care (N = 2,923) was tracked from the date on which they entered the program until the end of December 1992.
DATA EXTRACTION METHODS
Program administrative data were used to create spans of program experience for each client. Cox proportional hazards regression models were then used to assess the individual factors associated with the risk of nursing home entry during the study period.
PRINCIPAL FINDINGS
The greatest risk of nursing home entry was observed for those who were older or white, and for those clients with Alzheimer's disease. Little significant effect was observed for support system variables.
CONCLUSIONS
Study results suggest that efforts to prevent nursing home entry may be most productive if they focus on the point at which clients are first assessed for placement into the ALTCS program. Once in HCB care, subsequent risk of nursing home placement may be more related to the client's health and frailty than to support system factors.