Patterns of rehabilitation utilization after hip fracture in acute hospitals and skilled nursing facilities
Patterns of rehabilitation utilization after hip fracture in acute hospitals and skilled nursing facilities
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DOI：
10.1097/00005650-200011000-00006
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发表时间：
2000-11-01
期刊：
影响因子：
3
通讯作者：
Pakalniskis, A
中科院分区：
文献类型：
--
作者：
Harada, ND;Chun, A;Pakalniskis, A
背景资料。住院的髋部骨折患者可以在急性和/或急性后情况下接受物理治疗(PT)。PT的使用模式可能因患者、临床和医院的特点而异。目的：我们将PT的使用分为以下几种模式：仅急性PT、仅有熟练护理设施(SNF)PT、急性和SNF PT，以及无PT。对于每种模式，我们比较了(1)髋部骨折患者的特征，(2)住院时间(LOS)和(3)出院结果。研究对象包括187,990名来自医疗保险管理数据的住院髋部骨折患者。测量。因变量为PT使用模式、急性医院和SNF LOS、总发作护理天数和出院目的地。自变量是人口统计学、临床和设施特征。PT的使用模式也被用作LOS和出院目的地模型的自变量。结果：PT的使用模式受到人口统计学和临床特征的影响，如年龄、种族和手术类型。同样，不同的LOS措施和排放目的地也因PT的使用模式而异。接受急性PT的患者急性丧失时间较长；然而，随后转至SNFS的患者SNF丢失和总发作护理天数较短。使用PT的患者更有可能在急性或SNF住院后出院。结论：在老年和黑人等患者亚群中，PT的使用存在差异。供应商应确定启动PT的最合适环境，以便在有效利用资源的情况下实现更好的排放结果。
BACKGROUND. Hospitalized hip fracture patients may receive physical therapy (PT) in acute and/or postacute settings. Patterns of PT use may vary by patient, clinical, and hospital characteristics. These patterns can be analyzed if the acute and postacute stays are linked.OBJECTIVES. We classified the following patterns of PT use: acute PT only, skilled nursing facility (SNF) PT only, acute and SNF PT, and no PT. For each pattern, we compared (1) characteristics of hip fracture patients, (2) length of stay (LOS), and (3) discharge outcomes.SUBJECTS. The study included 187,990 hospitalized hip fracture patients derived from Medicare administrative data.MEASURES. Dependent variables were PT use patterns, acute hospital and SNF LOS, total episode days of care, and discharge destination. Independent variables were demographic, clinical, and facility characteristics. PT use patterns were also used as independent variables in the LOS and discharge destination models.RESULTS. Patterns of PT use were influenced by demographic and clinical characteristics such as age, race, and surgery type. Similarly, different LOS measures and discharge destinations varied by the PT use patterns. Patients receiving acute PT had longer acute LOSs; however, those patients who were subsequently transferred to SNFs had shorter SNF LOSs and total episode days of care. Patients utilizing PT were more likely to be discharged to home after the acute or SNF stay.CONCLUSIONS. Disparities in PT use exist for subgroups of patients such as the elderly and blacks. Providers should determine the most appropriate setting for initiation of PT to achieve better discharge outcomes with efficient use of resources.