Nursing Home Length of Stay in 3 Canadian Health Regions: Temporal Trends, Jurisdictional Differences, and Associated Factors
Nursing Home Length of Stay in 3 Canadian Health Regions: Temporal Trends, Jurisdictional Differences, and Associated Factors
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DOI：
10.1016/j.jamda.2019.01.144
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发表时间：
2019-09-01
影响因子：
7.6
通讯作者：
Estabrooks, Carole A.
中科院分区：
文献类型：
--
作者：
Hoben, Matthias;Chamberlain, Stephanie A.;Estabrooks, Carole A.
目的：评估(1)加拿大3个卫生辖区(埃德蒙顿、卡尔加里、温尼伯)疗养院(NH)住院时间(LOS)的时间变化(2008-2015)，(2)与LOS相关的住院特征，以及(3)每个辖区住院特征的时间变化。设计：采用先前在老年护理翻译研究(TREC)中收集的数据进行回顾性队列研究，背景和参与者：2008年1月至2015年12月入院的7817名居民，由自2007年以来一直参加TREC的18名NHS组成的稳定队列。方法：LOS定义为居民首次入院到最终出院之间的时间。分析包括描述性统计、Kaplan Meier估计(未调整的LOS)和Cox比例风险回归(调整后的LOS)，并根据居民特征(例如，年龄、认知表现和健康不稳定)进行调整。我们还控制了NH的大小和所有者。结果：在有越来越多护理需求的司法管辖区，未调整的中位数LOS[95%可信区间(CI)]随着时间的推移(2008年和2009年与2014年和2015年入院人数相比)下降；卡尔加里从1.837(95%可信区间1.618，2.275)下降到1.328(95%可信区间1.185，1.489)年；埃德蒙顿从1.927年(95%可信区间1.725，2.188)下降到1.073(95%可信区间0.936，1.248)年。在温尼伯，护理需求和LOS保持不变(2.163，95%CI 1.867，2.494，vs 2.459，95%CI 2.155，2.883，年)。居民特征包括较高的身体依赖性[危险比(HR)1.205，95%CI 1.133，1.282]、较高的认知损害(HR 1.112，95%CI 1.042，1.187)或较高的健康不稳定性(HR 1.333，95%CI 1.224，1.452)。对居民特征的调整减少了司法管辖区的LOS差异，使司法管辖区内的时间LOS差异在统计上没有显著意义。结论/影响：在自2008年以来入院时护理需求增加的司法管辖区，居民LOS减少。在护理需求和损失方面的管辖权差异表明，卫生政策可能会影响这些结果。居民成果因政策环境而异，需要进行额外的审查。(C)2019年AMDA--急性后和长期护理医学学会。
Objectives: To assess (1) temporal changes (2008-2015) in nursing home (NH) length of stay (LoS) in 3 Canadian health jurisdictions (Edmonton, Calgary, Winnipeg), (2) resident admission characteristics associated with LoS, and (3) temporal changes of admission characteristics in each of the 3 jurisdictions.Design: Retrospective cohort study using data previously collected in Translating Research in Elder Care (TREC), a longitudinal program of applied health services research in Canadian NHs.Setting and participants: 7817 residents admitted between January 2008 and December 2015 to a stable cohort of 18 NHs that have consistently participated in TREC since 2007.Methods: LoS was defined as time between a resident's first NH admission and final discharge from the NH sector. Analyses included descriptive statistics, Kaplan Meier estimates (unadjusted LoS), and Cox proportional hazard regressions (adjusted LoS), adjusted for resident characteristics (eg, age, cognitive performance, and health instability). We also controlled for NH size and ownership.Results: In jurisdictions with increasing care needs, unadjusted median LoS [95% confidence interval (CI)] decreased over time (2008 and 2009 vs 2014 and 2015 admissions); in Calgary from 1.837 (95% CI 1.618, 2.275) to 1.328 (95% CI 1.185,1.489) years and in Edmonton from 1.927 (95% CI 1.725, 2.188) to 1.073 (95% CI 0.936, 1.248) years. In Winnipeg, care needs and LoS remained constant (2.163, 95% CI 1.867, 2.494, vs 2.459, 95% CI 2.155, 2.883, years). Resident characteristics including higher physical dependency [hazard ratio (HR) 1.205, 95% CI 1.133, 1.282], higher cognitive impairment (HR 1.112, 95% CI 1.042, 1.187), or higher health instability (HR 1.333, 95% CI 1.224, 1.452) were associated with lower LoS. Adjustment for resident characteristics reduced jurisdictional LoS differences and rendered temporal LoS differences within jurisdictions statistically nonsignificant.Conclusions/Implications: In jurisdictions where care needs at admission have increased since 2008, resident LoS has decreased. Jurisdictional differences in care needs and LoS indicate that health policies may affect these outcomes. Variations of resident outcomes by policy environment require additional scrutiny. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.