Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
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DOI：
10.1111/jgs.17065
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发表时间：
2021-06
影响因子：
6.3
通讯作者：
Thomas KS
中科院分区：
文献类型：
--
作者：
Anderson MC;Evans E;Zonfrillo MR;Thomas KS
老年人中创伤性脑损伤（TBI）的发病率和在养老院对这一人群的治疗正在增加。本研究的目的是检验农村和城市地区老年脑外伤患者的护理质量和治疗结果的差异：1)比较社区成功出院率；2)农村和城市环境患者未能顺利出院的原因。使用与最小数据集评估相关的医疗保险住院索赔的SNF患者的回顾性国家队列研究。使用描述性统计比较了农村和城市环境的人口、健康和设施特征。使用状态随机效应的逻辑回归来识别预测成功放电的特征。美国专业护理机构（n=11,771）。2011年至2015年间，66岁以上的医疗保险受益人因脑外伤住院后出院至SNF （n = 61,021）。成功社区出院定义为在入院后100天内从SNF出院，并在社区中居住≥30天，没有死亡或住院医疗机构。农村地区未调整的成功出院率明显低于城市地区（52.1%比58.5%,p<0.01）。农村地区患者成功出院的调整后几率较低（OR 0.84, 95%CI=0.80-0.89）。未成功出院的原因在农村和城市环境中有所不同，农村患者在SNF出院后100天内出院的可能性较小，但在SNF出院后30天内再次住院的可能性也较小。考虑到农村患者总体社区出院成功率低且预后较差，有必要进一步研究探索干预措施，以改善这一人群的SNF护理和出院计划。
Rates of traumatic brain injury (TBI) among older adults and treatment of this population in nursing homes are increasing. The objective of this study is to examine differences in the quality of care and outcomes of older adults with TBI in rural and urban settings by 1) comparing the rates of successful community discharge; and 2) reasons for not achieving successful discharge among patients in rural and urban environments. Retrospective national cohort study of SNF patients using Medicare inpatient claims linked with Minimum Data Set assessments. Demographic, health, and facility characteristics were compared between rural and urban settings using descriptive statistics. Logistic regression with state random effects was used to identify characteristics that predicted successful discharge. U.S. skilled nursing facilities (n=11,771). Medicare beneficiaries aged 66+ discharged to a SNF following hospitalization for TBI between 2011 and 2015 (n = 61,021). Successful community discharge defined as discharge from SNF within 100 days of admission and remaining in the community for ≥ 30 days without dying or admission to an inpatient healthcare facility. Unadjusted rates of successful discharge were significantly lower for patients in rural settings compared to patients in urban settings (52.1% vs. 58.5%, p<0.01). Patients in rural settings had lower adjusted odds (OR 0.84, 95%CI=0.80-0.89) of successful discharge. Reasons for not discharging successfully differed between rural and urban settings with rural patients less likely to discharge from SNF within 100 days though also less likely to be re-hospitalized within 30 days of SNF discharge. Given the low overall rate of successful community discharge and worse outcomes among rural patients, further research to explore interventions to improve SNF care and discharge planning in this population is warranted.
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影响因子：
2.8
作者：
Anderson TJ;Saman DM;Lipsky MS;Lutfiyya MN
通讯作者：
Lutfiyya MN
DOI：
10.1093/gerona/gly044
发表时间：
2019-02-01
影响因子：
5.1
作者：
Thomas, Kali S.;Ogarek, Jessica A.;Mor, Vincent
通讯作者：
Mor, Vincent
影响因子：
3
作者：
Thomas KS;Dosa D;Wysocki A;Mor V
通讯作者：
Mor V
影响因子：
3.5
作者：
Cornell, Portia Y.;Grabowski, David C.;Rahman, Momotazur
通讯作者：
Rahman, Momotazur
影响因子：
4.2
作者：
Dams-O'Connor, Kristen;Cuthbert, Jeffrey P.;Harrison-Felix, Cynthia
通讯作者：
Harrison-Felix, Cynthia