Effects of Acute-Postacute Continuity on Community Discharge and 30-Day Rehospitalization Following Inpatient Rehabilitation.
Effects of Acute-Postacute Continuity on Community Discharge and 30-Day Rehospitalization Following Inpatient Rehabilitation.
复制标题
急性-急性后连续性对社区出院和住院康复后 30 天再住院的影响。
DOI：
10.1111/1475-6773.12678
复制
发表时间：
2017
影响因子：
3.4
通讯作者：
Ottenbacher,KennethJ
中科院分区：
文献类型：
--
作者：
Graham,JamesE;PrvuBettger,Janet;Middleton,Addie;Spratt,Heidi;Sharma,Gulshan;Ottenbacher,KennethJ
目的探讨医院急性-急性后连续性对住院康复后社区出院和30天再住院概率的影响。数据来源我们使用国家医疗保险登记、索赔和评估数据来研究2010-2011年间从1156家住院康复机构（irf）出院的541,097名患者。研究设计：我们计算了设施级连续性，即每个提供急性护理的医院收治的IRF患者的百分比。患者分为三组：低连续性（< 26%来自出院患者的同一家医院），中等连续性（26 - 75%来自同一家医院）或高连续性（100 - 75%来自同一家医院）。多变量模型包括一个相互作用项，以检验设施类型（独立式设施与医院康复单位）对设施水平连续性与我们的两个结果（社区出院和30天再住院）之间关系的潜在调节作用。主要发现：与独立康复机构相比，住院康复单位的医疗保险受益人更有可能从高贡献医院转诊。然而，在独立康复设施中，较高的急性-急性后连续性与理想预后之间的关联明显优于在医院康复设施中。结论提高连续性是医疗改革的关键前提。我们发现，观察到的转诊模式和连续性相关的益处因机构类型而有显著差异。这些发现为卫生系统在共享责任和公共质量报告计划的新时代建立或加强急性-急性后关系以改善患者预后提供了起点。
ObjectiveTo examine the effects of facility‐level acute–postacute continuity on probability of community discharge and 30‐day rehospitalization following inpatient rehabilitation.Data SourcesWe used national Medicare enrollment, claims, and assessment data to study 541,097 patients discharged from 1,156 inpatient rehabilitation facilities (IRFs) in 2010–2011.Study DesignWe calculated facility‐level continuity as the percentages of an IRF's patients admitted from each contributing acute care hospital. Patients were categorized into three groups: low continuity (<26 percent from same hospital that discharged the patient), medium continuity (26–75 percent from same hospital), or high continuity (>75 percent from same hospital). The multivariable models included an interaction term to examine the potential moderating effects of facility type (freestanding facility vs. hospital‐based rehabilitation unit) on the relationships between facility‐level continuity and our two outcomes: community discharge and 30‐day rehospitalization.Principal FindingsMedicare beneficiaries in hospital‐based rehabilitation units were more likely to be referred from a high‐contributing hospital compared to those in freestanding facilities. However, the association between higher acute–postacute continuity and desirable outcomes is significantly better in freestanding rehabilitation facilities than in hospital‐based units.ConclusionsImproving continuity is a key premise of health care reform. We found that both observed referral patterns and continuity‐related benefits differed markedly by facility type. These findings provide a starting point for health systems establishing or strengthening acute–postacute relationships to improve patient outcomes in this new era of shared accountability and public quality reporting programs.