Referral to Community-Based Rehabilitation Following Acute Stroke: Findings From the COMPASS Pragmatic Trial.
Referral to Community-Based Rehabilitation Following Acute Stroke: Findings From the COMPASS Pragmatic Trial.
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急性中风后转介至社区康复：COMPASS 实用试验的结果。
DOI：
10.1161/circoutcomes.123.010026
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Freburger,JanetK
中科院分区：
文献类型：
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作者：
JonesBerkeley,SaraB;Johnson,AnnaM;Mormer,ElizabethR;Ressel,Kristin;Pastva,AmyM;Wen,Fang;Patterson,CharityG;Duncan,PamelaW;Bushnell,CherylD;Zhang,Shuqi;Freburger,JanetK
少数关于急性卒中后护理过渡的研究评估了转诊到社区康复是否作为出院计划的一部分。我们的目标是描述在何种程度上出院回家的患者被称为社区为基础的康复，并确定患者，医院和社区水平的reference.METHODSWe的预测因素40北卡罗来纳州医院参加了COMPASS（综合急性卒中后服务）的集群随机试验的数据。参与者包括中风或短暂性脑缺血发作后出院的成年人（N=10 702）。在这项观察性分析中，COMPASS数据补充了来自不同来源的医院级和县级数据。主要结局是出院时转诊至社区康复（物理、职业或语言治疗）。预测变量包括患者（人口统计学、卒中相关、病史）、医院（结构、过程）和社区（治疗师供应）措施。我们使用广义线性混合模型，医院随机效应和分层后向模型选择程序来确定治疗转介的预测因子。大约三分之一（36%）的中风幸存者（平均年龄66.8 [SD，14.0]岁; 49%女性，72%白色种族）被转介到社区康复。转诊到物理治疗师、职业治疗师和语言治疗师的比例分别为31%、18%和10%。各医院的转诊率范围为3%至78%，中位数为35%。患者水平的预测因素包括卒中严重程度较高、存在内科合并症和年龄较大。女性（比值比，1.24 [95%CI，1.12-1.38]）、非白人（2.20 [2.01-2.44]）和有医疗保险（1.12 [1.02-1.23]）也是转诊的预测因素。转诊率较高的病人生活在县与更多的物理治疗师供应。转诊跨医院的变化仍然unexplained. CONCLUSIONSONE三分之一的中风幸存者被转介到社区为基础的康复。患者水平因素作为预测因素占主导地位。各医院之间的差异是显著的，这为进一步评估和改善卒中后康复护理的可能目标提供了机会。https://www.clinicaltrials.gov
BACKGROUNDFew studies on care transitions following acute stroke have evaluated whether referral to community-based rehabilitation occurred as part of discharge planning. Our objectives were to describe the extent to which patients discharged home were referred to community-based rehabilitation and identify the patient, hospital, and community-level predictors of referral.METHODSWe examined data from 40 North Carolina hospitals that participated in the COMPASS (Comprehensive Post-Acute Stroke Services) cluster-randomized trial. Participants included adults discharged home following stroke or transient ischemic attack (N=10 702). In this observational analysis, COMPASS data were supplemented with hospital-level and county-level data from various sources. The primary outcome was referral to community-based rehabilitation (physical, occupational, or speech therapy) at discharge. Predictor variables included patient (demographic, stroke-related, medical history), hospital (structure, process), and community (therapist supply) measures. We used generalized linear mixed models with a hospital random effect and hierarchical backward model selection procedures to identify predictors of therapy referral.RESULTSApproximately, one-third (36%) of stroke survivors (mean age, 66.8 [SD, 14.0] years; 49% female, 72% White race) were referred to community-based rehabilitation. Rates of referral to physical, occupational, and speech therapists were 31%, 18%, and 10%, respectively. Referral rates by hospital ranged from 3% to 78% with a median of 35%. Patient-level predictors included higher stroke severity, presence of medical comorbidities, and older age. Female sex (odds ratio, 1.24 [95% CI, 1.12–1.38]), non-White race (2.20 [2.01–2.44]), and having Medicare insurance (1.12 [1.02–1.23]) were also predictors of referral. Referral was higher for patients living in counties with greater physical therapist supply. Much of the variation in referral across hospitals remained unexplained.CONCLUSIONSOne-third of stroke survivors were referred to community-based rehabilitation. Patient-level factors predominated as predictors. Variation across hospitals was notable and presents an opportunity for further evaluation and possible targets for improved poststroke rehabilitative care.REGISTRATIONURL: https://www.clinicaltrials.gov; Unique identifier: NCT02588664.