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出院后被送往熟练的护理设施(SNF) 急性护理和康复，每年住院人数超过200万人次。尽管SNF留下来的目的是 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致死的现象 在社区里活着，在医院外或三军部队生活。然而，在家中短时间评估风险的工具 还没有在特殊情况下发展，确定这些因素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。尽管康复干预改善了非虚弱人群的功能和预后 在门诊环境中，身体虚弱的成年人与更健壮的老年人相比并不能从中受益 康复方法。此外，是否存在可改变的危险因素，如精神错乱、抑郁和 可能不适当的药物(PIM)，独立影响在家短时间内的虚弱设置是 不清楚。因此，脆弱的措施有可能在短时间内对康复患者进行风险分层。 同时告知目标有意义和有效的干预措施。 这项建议旨在阐明井中固氮排出后短时间在家的预测因素。 建立脆弱的衡量标准和可修改的风险因素。这项研究将利用现有的数据集 医疗保险受益者的全国代表性队列，国家健康和老龄化趋势研究 (NHATS)与联邦医疗保险索赔相关。具体目标是：1)评估和比较两个人的能力 入院前脆弱程度对急性SNF康复后在家短时间的预测 全国代表性的医疗保险受益者队列，以及2)确定可改变的危险因素(精神错乱， 抑郁、PIM、康复特征)，这些与在家中的短时间独立相关 急性三七神经营养不良后康复。 影响：该奖项将支持首席调查员(PI)的早期职业发展和途径 成为全国老年急性期康复领域的领先者。作为一名有老龄化经验的老年病医生 研究，史博士将从康复医学中获得新的洞察力和视角，并发展技能 设计和领导多学科的SNF康复干预措施。这项提议得到了一个合作伙伴的支持 拥有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的基础知识的绩效指标 SNF康复后在家中短暂停留。这样做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做的干预措施，最大限度地延长他们在家中的时间。

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.