Trends in post-acute care and outcomes for Medicare beneficiaries hospitalized for heart failure between 2008 and 2015.
Trends in post-acute care and outcomes for Medicare beneficiaries hospitalized for heart failure between 2008 and 2015.
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2008 年至 2015 年间因心力衰竭住院的医疗保险受益人的急性后期护理和结果趋势。
DOI：
10.1111/jgs.18109
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发表时间：
2023
影响因子：
6.3
通讯作者：
Gozalo,Pedro
中科院分区：
文献类型：
--
作者：
Keeney,Tamra;Lake,Derek;Varma,Hiren;Resnik,Linda;Teno,JoanM;Grabowski,DavidC;Gozalo,Pedro
背景心力衰竭（HF）是美国老年人住院的主要原因，并导致高比率的急性后护理（PAC）利用。联邦政策的重点是将PAC转移到强度较低的环境中，并减少停留时间以降低支出。本研究通过（1）描述PAC使用和成本的趋势，（2）评估总体和虚弱程度的再入院率、死亡率和社区天数的变化，评估政策变化对2008年至2015年期间因HF住院的医疗保险受益人使用PAC的影响。方法：在2008年1月1日至2015年9月30日期间，在所有医疗保险按服务付费受益人（n= 718，737）的20%随机样本中，所有HF入院的年度横断面前瞻性队列。使用基于声明的虚弱指数（CFI）对虚弱状态进行分类。多变量回归模型用于评估首次出院地点、再入院、死亡率、社区生存天数和成本的趋势;总体和虚弱状态。结果心衰患者普遍存在虚弱，虚弱前期占54.1%，轻度虚弱占37.0%，中重度虚弱占6.9%。在2008年至2015年期间，接受PAC的HF受益人增加了近4%，其中大部分增加集中在熟练护理设施（SNF）（+ 2.3%）和家庭保健机构（HHA）（+1.1%），PAC成本增加123（3.5%）。在住院治疗后的180天内，再入院率显著下降（30天时为-3.4%; 180天时为-6.3%），死亡率增加（+1.5%），180天医疗费用下降2948（-18.7%），对死亡率没有负面影响（除了虚弱前期组略有增加）。在最虚弱的患者中，收益最大。结论：因HF住院的医疗保险受益人在社区花费更多的时间，并以较低的费用经历了较低的再住院率，而死亡率没有显着增加。然而，重要的机会仍然是优化护理体弱老年人住院HF。
Background Heart failure (HF) is the leading cause of hospitalization among older adults in the United States and results in high rates of post‐acute care (PAC) utilization. Federal policies have focused on shifting PAC to less intensive settings and reducing length of stay to lower spending. This study evaluates the impact of policy changes on PAC use among Medicare beneficiaries hospitalized with HF between 2008 and 2015 by (1) characterizing trends in PAC use and cost and (2) evaluating changes in readmission, mortality, and days in the community, overall and by frailty. Methods Annual cross‐section prospective cohorts of all HF admissions between 1/1/2008 and 9/30/2015 among a 20% random sample of all Medicare Fee‐for‐Service beneficiaries (n= 718,737). The Claims‐based Frailty Index (CFI) was used to classify frailty status. Multivariable regression models were used to evaluate trends in first discharge location, readmissions, mortality, days alive in the community, and costs; overall and by frailty status. Results Frailty was prevalent among HF patients: 54.1% were prefrail, 37.0% mildly frail, and 6.9% moderate to severely frail. Between 2008 and 2015, almost 4% more HF beneficiaries received PAC, with most of the increase concentrated in skilled nursing facilities (SNF)(+ 2.3%) and home health agencies (HHA)(+ 1.1%), and PAC cost increased by 123(3.5%).Overthe180‐daysfollow‐upafterhospitalization,hospitalreadmissionsdecreasedsignificantly(−3.4%at30‐day;−6.3%at180‐day),daysaliveinthecommunityincreased(+1.5),and180‐dayMedicarecostsdeclined 2948 (− 18.7%) without negative impact in mortality (except a minor increase in the pre‐frail group). Gains were greatest among the frailest patients. Conclusions Medicare beneficiaries hospitalized with HF spent more time in the community and experienced lower rehospitalization rates at lower cost without significant increases in mortality. However, important opportunities remain to optimize care for frail older adults hospitalized with HF.