Variation in Inpatient Rehabilitation Utilization After Hospitalization for Burn Injury in the United States
Variation in Inpatient Rehabilitation Utilization After Hospitalization for Burn Injury in the United States
复制标题
DOI：
10.1097/bcr.0000000000000200
复制
发表时间：
2015-11-01
影响因子：
1.4
通讯作者：
Rivara, Frederick P.
中科院分区：
文献类型：
--
作者：
Greene, Nathaniel H.;Pham, Tam N.;Rivara, Frederick P.
每年约有45 000人住院接受烧伤治疗。住院后的康复可以提供功能结果的显着改善。全国对烧伤康复知之甚少，根据观察到的医疗保险住院后支出金额，不同地区的做法可能有很大差异。本研究旨在测量烧伤住院患者住院状态下康复利用的变化。这项回顾性队列研究使用了10年期间（2001年至2010年）从医疗保健成本和利用项目（HCUP）国家住院患者数据库（SID）收集的全国数据。通过ICD-9-CM代码识别因烧伤住院的患者（n = 57，968），并对其进行检查，以明确他们是否在住院后立即出院进行住院康复（主要终点）。考虑到年龄、保险状况、在烧伤中心的住院情况和烧伤程度（TBSA）的影响，计算了每个州未经调整和调整的可能性。出院到住院康复的相对风险在不同的州之间变化多达6倍。较高的TBSA、有健康保险、较高的年龄和烧伤中心住院治疗都增加了急性护理住院后出院到住院康复的可能性。在调整已知影响每个结果的变量后，住院康复利用率在各州之间存在显著差异。未来的努力应该集中在确定这种州与州之间差异的原因，其与患者结局的关系，以及在美国范围内标准化治疗。
Approximately 45,000 individuals are hospitalized annually for burn treatment. Rehabilitation after hospitalization can offer a significant improvement in functional outcomes. Very little is known nationally about rehabilitation for burns, and practices may vary substantially depending on the region based on observed Medicare post-hospitalization spending amounts. This study was designed to measure variation in rehabilitation utilization by state of hospitalization for patients hospitalized with burn injury. This retrospective cohort study used nationally collected data over a 10-year period (2001 to 2010), from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs). Patients hospitalized for burn injury (n = 57,968) were identified by ICD-9-CM codes and were examined to see specifically if they were discharged immediately to inpatient rehabilitation after hospitalization (primary endpoint). Both unadjusted and adjusted likelihoods were calculated for each state taking into account the effects of age, insurance status, hospitalization at a burn center, and extent of burn injury by TBSA. The relative risk of discharge to inpatient rehabilitation varied by as much as 6-fold among different states. Higher TBSA, having health insurance, higher age, and burn center hospitalization all increased the likelihood of discharge to inpatient rehabilitation following acute care hospitalization. There was significant variation between states in inpatient rehabilitation utilization after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.