Hospital Variation in Skilled Nursing Facility Use After Coronary Artery Bypass Graft Surgery.
Hospital Variation in Skilled Nursing Facility Use After Coronary Artery Bypass Graft Surgery.
复制标题
冠状动脉搭桥移植手术后医院熟练护理设施使用情况的变化。
DOI：
10.1161/jaha.123.029833
复制
发表时间：
2024
影响因子：
5.4
通讯作者：
Thompson,MichaelP
中科院分区：
文献类型：
--
作者：
Stewart2nd,JamesW;Hou,Hechuan;Hawkins,RobertB;Pagani,FrancisD;Sterling,MadelineR;Likosky,DonaldS;Thompson,MichaelP
背景超过 20% 的患者在冠状动脉搭桥手术后出院到专业护理机构 (SNF)，但对于出院后使用 SNF 的具体驱动因素知之甚少。本研究的目的是评估医院 SNF 使用情况的差异及其与冠状动脉旁路移植术后结果的关系。方法和结果利用医疗保险提供者分析和审查文件进行回顾性研究设计，用于评估 2016 年至 2018 年间接受冠状动脉旁路移植术（无论有或没有瓣膜手术）的 70%~509 名受益人的 SNF 使用情况。共有 17%~328 人（24.6%）出院到医院。 SNF，871 家医院的 SNF 范围从 0% 到 88%。多级逻辑回归模型确定了出院至 SNF 的重要患者水平预测因素，包括年龄增加、合并症、女性、黑人种族、双重资格和术后并发症。调整患者和医院因素后，医院 SNF 使用变化的 15.6% 归因于出院医院。与医院 SNF 使用率较低的四分位相比，SNF 使用率较高的医院出院患者的风险调整 1 年死亡率（12.5% 对比 8.6%，P<0.001）和再入院率（59.9% 对比 49.8%，P<0.001）较低。 结论 医院之间 SNF 使用情况存在很大差异，这只能部分由患者特征解释。 SNF 使用率较高的医院出院至 SNF 的患者的风险调整后 1 年死亡率和再入院率较低。需要做更多的工作来更好地了解导致 SNF 使用变异性的潜在提供者和医院层面的因素。
BackgroundOver 20% of patients are discharged to a skilled nursing facility (SNF) after coronary artery bypass graft surgery, but little is known about specific drivers for postdischarge SNF use. The purpose of this study was to evaluate hospital variation in SNF use and its association with postoperative outcomes after coronary artery bypass graft.Methods and ResultsA retrospective study design utilizing Medicare Provider Analysis and Review files was used to evaluate SNF use among 70 509 beneficiaries undergoing coronary artery bypass graft, with or without valve procedures, between 2016 and 2018. A total of 17 328 (24.6%) were discharged to a SNF, ranging from 0% to 88% across 871 hospitals. Multilevel logistic regression models identified significant patient‐level predictors of discharge to SNF including increasing age, comorbidities, female sex, Black race, dual eligibility, and postoperative complications. After adjusting for patient and hospital factors, 15.6% of the variation in hospital SNF use was attributed to the discharging hospital. Compared with the lower quartile of hospital SNF use, hospitals in the top quartile of SNF use had lower risk‐adjusted 1‐year mortality (12.5% versus 8.6%,P<0.001) and readmission (59.9% versus 49.8%,P<0.001) rates for patients discharged to a SNF.ConclusionsThere is high variability in SNF use among hospitals that is only partially explained by patient characteristics. Hospitals with higher SNF utilization had lower risk‐adjusted 1‐year mortality and readmission rates for patients discharged to a SNF. More work is needed to better understand underlying provider and hospital‐level factors contributing to SNF use variability.
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