Marriage Status Predicts Hospital Outcomes Following Orthopedic Trauma
Marriage Status Predicts Hospital Outcomes Following Orthopedic Trauma
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DOI：
10.1177/2151459319898648
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发表时间：
2020-01-08
影响因子：
1.6
通讯作者：
Egol, Kenneth A.
中科院分区：
文献类型：
--
作者：
Konda, Sanjit R.;Gonzalez, Leah J.;Egol, Kenneth A.
简介：患者和付款人的急症后护理设施费用不断上涨，使得出院后出院回家，无论有没有家庭帮助，对各方来说都是一个有利的选择。我们的目标是评估婚姻状况对住院后处置的影响，婚姻状况是许多人社会支持的重要来源。方法：患者被前瞻性地输入一个大型学术医疗中心的机构审查委员会批准的创伤数据库。 2014 年至 2017 年间发生过任何骨折的年龄 55 岁或以上的患者均纳入其中。回顾性地，他们的关系状态是通过审查患者记录来记录的。 “已婚”状态与那些自我报告为“单身”、“离婚”或“丧偶”状态的人是分开的。使用多项逻辑回归来评估出院地点是否因婚姻状况而异，同时控制人口统计和伤害特征。结果：1931名患者中，离婚率为8.3%，单身率为29.9%，丧偶率为20.0%，已婚率为41.8%。出院处置与婚姻状况之间存在显着相关性。在控制年龄、性别、老年和中年评分中的创伤分诊评分以及保险类型后，与已婚患者相比，单身患者出院到疗养院、长期护理机构或专业护理机构的几率为 1.71 倍，丧偶患者为 1.80 倍。此外，单身和丧偶患者的住院时间分别是已婚患者的 1.36 倍和 1.30 倍。讨论：被确定为“单身”或“丧偶”的患者应尽早进行社会工作干预，以建立明确的出院期望。以这种方式进行早期干预可以让患者有时间与活着的亲密亲戚或朋友联系，他们可能能够提供足够的支持，以便患者可以回家。提高这些患者的出院率将减少住院时间，并减少患者和付款人的急性后期护理费用，而不会显着改变计划外的再入院率。
Introduction: Rising costs of post-acute care facilities for both the patient and payers make discharge home after hospital stay, with or without home help, a favorable alternative for all parties. Our objectives were to assess the effect of marital status, a large source of social support for many, on disposition following hospital stay. Methods: Patients were prospectively entered into an institutional review board-approved, trauma database at a large, academic medical center. Patients aged 55 years or older with any fracture injury between 2014 and 2017 were included. Retrospectively, their relationship status was recorded through review of patient records. A status of "married" was separated from those with a status self-reported as "single," "divorced," or "widowed." Multinomial logistic regression was used to assess whether discharge location differs by marital status while controlling for demographics and injury characteristics. Results: Of 1931 patients, 8.3% were divorced, 29.9% were single, 20.0% were widowed, and 41.8% were married. There was a significant correlation between discharge disposition and marital status. Single patients had 1.71 times, and widowed patients had 1.80 times, the odds of being discharged to a nursing home, long-term care facility, or skilled nursing facility compared to married patients after controlling for age, gender, Score for Trauma Triage in the Geriatric and Middle-Aged score, and insurance type. Additionally, single and widowed patients experienced 1.36 and 1.30 times longer length of hospital stay than their married counterparts, respectively. Discussion: Patients who are identified as "single" or "widowed" should have early social work intervention to establish clear discharge expectations. Early intervention in this way would allow time for contact with close, living relatives or friends who may be able to provide sufficient support so that patients can return home. Increasing home discharge rates for these patients would reduce lengths of hospital stay and reduce post-acute care costs for both patient and payers without materially altering unplanned readmission rates.