Discharge setting for patients with hip fracture: Trends from 2001 to 2005
Discharge setting for patients with hip fracture: Trends from 2001 to 2005
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DOI：
10.1111/j.1532-5415.2008.01688.x
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发表时间：
2008-06-01
影响因子：
6.3
通讯作者：
Ottenbacher, Kenneth J.
中科院分区：
文献类型：
--
作者：
Nguyen-Oghalai, Tracy U.;Kuo, Yong-fang;Ottenbacher, Kenneth J.
目的：探讨髋部骨折住院后出院处置的最新趋势。设计：回顾性观察性研究，数据来自2001年至2005年医疗保险索赔数据的5%随机样本，这些数据是医疗保险和医疗补助服务中心为研究目的提供的。背景：住院医疗康复的前后预期付款的实施（2001-2005）。参与者：44,684名医疗保险患者。措施：急性出院后设置（家庭、住院康复、熟练护理设施和长期护理养老院/医院/临终关怀）。结果：双变量分析显示，急症康复出院率由2001年的12.2%上升至2005年的23.9%。在调整患者特征（年龄、性别、种族或民族）、入院诊断、治疗类型（内固定vs关节置换术）和住院时间后，2005年住院医疗康复出院的几率比2001年高2.26（95%可信区间=2.09-2.45）。结论：髋部骨折患者急性期后服务从按服务收费向预期付费的转变与住院医疗康复的更多使用有关。需要进一步的研究来确认出院环境的趋势，并确定其是否与急性后护理报销的变化有关。
OBJECTIVES: To examine recent trends in discharge disposition after hospitalization for hip fracture.DESIGN: Retrospective observational study using data from the 5% random sample of Medicare claims data from 2001 to 2005 that the Centers for Medicare and Medicaid Services makes available for research purposes.SETTING: Inpatient medical rehabilitation pre- and postimplementation of prospective payment (2001-2005).PARTICIPANTS: Forty-four thousand six hundred eighty-four Medicare patients.MEASURES: Postacute discharge setting (home, inpatient rehabilitation, skilled nursing facility, and long-term care nursing home/hospital/hospice).RESULTS: Bivariate analyses showed that discharge from acute care to inpatient rehabilitation increased from 12.2% in 2001 to 23.9% in 2005. The odds of discharge to inpatient medical rehabilitation were 2.26 (95% confidence interval=2.09-2.45) greater in 2005 than in 2001 after adjustment for patient characteristics (age, sex, and race or ethnicity), admitting diagnoses, type of treatment (internal fixation vs arthroplasty), and length of stay.CONCLUSION: The move from fee for service to prospective payment for postacute services for persons with hip fracture was associated with greater use of inpatient medical rehabilitation. Further research is necessary to confirm the trend in discharge setting and determine whether it is related to changes in reimbursement for postacute care.