The increased needs of patients in nursing homes and patients receiving home health care.
The increased needs of patients in nursing homes and patients receiving home health care.
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疗养院患者和接受家庭医疗保健的患者的需求增加。
DOI：
10.1056/nejm199001043220105
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Andrew M. Kramer
中科院分区：
文献类型：
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作者：
P. Shaughnessy;Andrew M. Kramer
为了评估医疗保险的预期支付系统和医疗补助的入院前规定对长期护理的影响，我们在1982年和1986年建立了大约500名随机选择的病人的临床档案，这些病人来自三种类型的设施：医疗保险病人比例相对较高的疗养院（高医疗保险养老院; n = 23），传统养老院（n = 19）和家庭健康机构（n = 18）。数据直接从护理人员那里获得的医疗问题，需要熟练护理的问题，以及来自12个州的这些代表性患者的功能问题。对于高医疗保险护理之家的医疗保险患者，医疗问题和需要熟练护理的问题的患病率大幅增加，而功能问题的患病率相对保持不变。例如，从1982年到1986年，管饲（21%到29%）、吸氧（6%到14%）、尿路感染（7%到13%）和舒张期高血压（1%到10%）的频率显著增加，但进食（48%到51%）或说话（28%到29%）困难的频率没有增加。相比之下，在传统的疗养院，功能性残疾的患病率有所增加，但需要医疗和熟练护理的问题几乎没有变化。在家庭保健方面，医疗保险患者的功能性护理需求显著增加，需要医疗和熟练护理的问题的患病率略有增加。我们的结论是，从1982年至1986年的长期护理病人的需求大幅增加。这一趋势似乎是由于医疗保险的预期支付系统，鼓励早期出院到长期护理机构，并从医疗补助的去机构化政策。满足这种更大的护理需求将是昂贵的。我们需要一个更好的长期护理报销制度，并确保其质量。
To evaluate the effects of Medicare's prospective payment system and Medicaid's preadmission regulations on long-term care, we constructed clinical profiles in 1982 and 1986 of about 500 randomly selected patients from each of three types of facilities: nursing homes with relatively high proportions of Medicare patients (high-Medicare nursing homes; n = 23), traditional nursing homes (n = 19), and home health agencies (n = 18). Data were obtained directly from the care givers on the medical problems, problems requiring skilled nursing, and functional problems of these representative patients from 12 states. For Medicare patients in high-Medicare nursing homes, the prevalence of medical problems and problems requiring skilled nursing increased substantially, whereas the prevalence of functional problems remained relatively unchanged. For example, from 1982 to 1986 there was a marked increase in the frequency of tube feedings (21 to 29 percent), oxygen use (6 to 14 percent), urinary tract infection (7 to 13 percent), and diastolic hypertension (1 to 10 percent), but not difficulty in eating (48 to 51 percent) or speaking (28 to 29 percent). In contrast, in traditional nursing homes there was an increase in the prevalence of functional disability, but virtually no change in that of problems requiring medical and skilled nursing care. In home health care the functional care needs of Medicare patients increased significantly, and there was a slight increase in the prevalence of problems requiring medical and skilled nursing care. We conclude that from 1982 to 1986 the needs of patients in long-term care increased substantially. This trend appears to result from Medicare's prospective payment system, which encourages earlier hospital discharge to long-term care settings, and from Medicaid's policy of de-institutionalization. Meeting this greater need for care will be costly. We require a better system of reimbursing for long-term care and ensuring its quality.