Poststroke Rehabilitation and Restorative Care Utilization A Comparison Between VA Community Living Centers and VA-contracted Community Nursing Homes
Poststroke Rehabilitation and Restorative Care Utilization A Comparison Between VA Community Living Centers and VA-contracted Community Nursing Homes
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DOI：
10.1097/mlr.0000000000000494
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发表时间：
2016-03-01
期刊：
影响因子：
3
通讯作者：
Hoffman, Nannette
中科院分区：
文献类型：
--
作者：
Jia, Huanguang;Pei, Qinglin;Hoffman, Nannette
背景：有效的脑卒中后康复护理可以加速患者康复，减少患者功能障碍。退伍军人事务（VA）社区生活中心（CLCs）和退伍军人合同社区养老院（CNHs）是接受退伍军人事务部支持的中风退伍军人机构长期护理的两个主要来源。目的：本研究比较退伍军人社区中心和退伍军人社区中心的康复治疗和恢复性护理。研究设计：回顾性观察。受试者：所有被诊断为中风的退伍军人，在研究期间新入住CLCs或CNHs，并在入院后完成至少2个最小数据集评估。测量方法：结果是退伍军人在CLCs或CNHs停留期间接受康复治疗和恢复性护理的天数，记录在最小数据集数据库中。结果：在康复治疗方面，CLC退伍军人的使用率低于CNH退伍军人（75.2% vs. 76.4%， P=0.078），观察治疗天数少于CNH退伍军人（4.9 vs. 6.4, P < 0.001）。然而，CLC退伍军人虽然平均治疗天数较少（系数=-1.53 +/- 0.11,P < 0.001），但接受治疗的调整几率更高（优势比=1.16，P=0.033）。在恢复性护理方面，CLC退伍军人的使用率更高（33.5%比30.6%,P < 0.001），观察到的平均护理天数更多（9.4比5.9,P < 0.001），调整优势更高（优势比=2.28,P < 0.001），恢复性护理调整天数更多（系数=5.48 +/- 0.37,P < 0.001）。结论：与退伍军人康复中心相比，退伍军人康复中心的退伍军人平均康复治疗天数（未调整和调整）较短，但在风险调整前后接受恢复性护理的可能性均显著高于退伍军人康复中心。
Background:Effective poststroke rehabilitation care can speed patient recovery and minimize patient functional disabilities. Veterans affairs (VA) community living centers (CLCs) and VA-contracted community nursing homes (CNHs) are the 2 major sources of institutional long-term care for Veterans with stroke receiving care under VA auspices.Objectives:This study compares rehabilitation therapy and restorative nursing care among Veterans residing in VA CLCs versus those Veterans in VA-contracted CNHs.Research Design:Retrospective observational.Subjects:All Veterans diagnosed with stroke, newly admitted to the CLCs or CNHs during the study period who completed at least 2 Minimum Data Set assessments postadmission.Measures:The outcomes were numbers of days for rehabilitation therapy and restorative nursing care received by the Veterans during their stays in CLCs or CNHs as documented in the Minimum Data Set databases.Results:For rehabilitation therapy, the CLC Veterans had lower user rates (75.2% vs. 76.4%, P=0.078) and fewer observed therapy days (4.9 vs. 6.4, P < 0.001) than CNH Veterans. However, the CLC Veterans had higher adjusted odds for therapy (odds ratio=1.16, P=0.033), although they had fewer average therapy days (coefficient=-1.53 +/- 0.11, P < 0.001). For restorative nursing care, CLC Veterans had higher user rates (33.5% vs. 30.6%, P < 0.001), more observed average care days (9.4 vs. 5.9, P < 0.001), higher adjusted odds (odds ratio=2.28, P < 0.001), and more adjusted days for restorative nursing care (coefficient=5.48 +/- 0.37, P < 0.001).Conclusion:Compared with their counterparts at VA-contracted CNHs, Veterans at VA CLCs had fewer average rehabilitation therapy days (both unadjusted and adjusted), but they were significantly more likely to receive restorative nursing care both before and after risk adjustment.