Predicting and Identifying Risk Factors for Short Time at Home in Older Adults after Hospitalization

摘要 住院后的时间是老年人从急性医疗问题中恢复的关键窗口。 大约五分之一的医疗保险受益人从医院出院到专业护理机构（SNF）进行术后护理。 急性护理和康复，每年超过200万人次。尽管SNF的停留旨在 恢复独立性和功能，许多患者在再次住院和SNF之间循环， 螺旋形。在家的时间通过计算天数来量化这种被'康复至死'的现象 在社区里活着，走出医院或SNF。然而，在家短时间评估风险的工具 在SNF环境中还没有开发，确定这些可以为干预措施的设计提供信息。 虚弱是一种常见的脆弱状态，已知会增加住院和死亡的风险 在老年人中。虽然康复干预可以改善非体弱者的功能和结果， 在门诊设置的成年人，虚弱相比，更强大的老年人不受益于相同的 康复方法。此外，是否可改变的风险因素，如谵妄，抑郁症， 潜在的不适当的药物（PIM），独立影响短时间在家里的设置脆弱是 不清楚因此，脆弱性措施有可能在家中短时间内对康复患者进行风险分层 同时为有意义和有效的干预措施提供信息。 该建议旨在阐明SNF排放后在家中短时间的预测因素， 建立了脆弱的措施和可修改的风险因素。这项研究将利用现有的数据集， 国家健康和老龄化趋势研究（National Health and Aging Trends Study） （NHATS）与医疗保险索赔有关。具体目的是：1）评估和比较两个能力 入院前虚弱的措施，以预测短期内在家里后，急性SNF康复，在一个 医疗保险受益人的全国代表性队列，和2）识别可改变的风险因素（谵妄， 抑郁症，PIM，康复特征）与术后在家时间短独立相关 急性SNF后康复。 影响：该奖项将支持主要研究者（PI）的早期职业发展和 成为全国老年急性SNF后康复的领导者。作为一个有着老龄化经验的老年病学家 研究，施博士将获得新的见解和观点，从康复医学和发展的技能， 设计和领导多学科SNF康复干预措施。这一建议得到了一个合作伙伴的支持。 经验丰富的导师团队和丰富的研究环境。研究和培训将提供 具有纵向数据分析、风险分层和可修改风险因素基础知识的PI 在SNF康复后的短时间内在家。在这样做的过程中，它将导致下一个合乎逻辑的步骤：设计和 根据老年患者的虚弱状况评估量身定制的干预措施，最大限度地延长他们在家的时间。

ABSTRACT The time after hospitalization is a critical window for older adults recovering from acute medical problems. Roughly 1 in 5 Medicare beneficiaries are discharged from hospital to skilled nursing facilities (SNFs) for post- acute care and rehabilitation, accounting for over 2 million stays annually. Although SNF stays are intended to restore independence and function, many patients cycle between re-hospitalizations and SNF in a downward spiral. Time at home quantifies this phenomenon of being ‘rehabbed to death’ by counting the number of days spent alive in the community, out of the hospital or SNF. However, tools that assess risk for short time at home have not been developed in the SNF setting, and identifying these can inform the design of interventions. Frailty is a common state of vulnerability known to increase risks of hospitalizations and mortality among older adults. Although rehabilitation interventions improve function and outcomes among non-frail adults in outpatient settings, frail compared to more robust older adults do not benefit from the same rehabilitation approaches. Moreover, whether modifiable risk factors such as delirium, depression, and potentially inappropriate medications (PIMs), independently impact short time at home in the setting of frailty is unclear. Thus, frailty measures have the potential to risk-stratify rehabilitation patients for short time at home while informing targeting of meaningful and efficacious interventions. This proposal aims to elucidate predictors of short time at home after SNF discharge among well- established frailty measures and modifiable risk factors. This research will leverage an existing dataset of a nationally representative cohort of Medicare beneficiaries, the National Health and Aging Trends Study (NHATS) linked to Medicare claims. The specific aims are to: 1) Assess and compare the ability of two measures of pre-hospitalization frailty to predict short time at home after post-acute SNF rehabilitation, in a nationally representative cohort of Medicare beneficiaries, and 2) Identify modifiable risk factors (delirium, depression, PIMs, rehabilitation characteristics) that are independently associated with short time at home after post-acute SNF rehabilitation. IMPACT: This award will support the principal investigator’s (PI’s) early career development and pathway to becoming a national leader in geriatric post-acute SNF rehabilitation. As a geriatrician with experience in aging research, Dr. Shi will acquire new insight and perspective from rehabilitation medicine and develop the skills to design and lead multidisciplinary SNF rehabilitation interventions. This proposal is supported by a collaborative team of highly experienced mentors and a rich research environment. The research and training will provide the PI with foundational knowledge in longitudinal data analysis, risk stratification, and modifiable risk factors for short time at home after SNF rehabilitation. In doing so, it will lead to the next logical step: designing and evaluating a tailored intervention guided by the frailty status of older patients, maximizing their time at home.