VA Post-Stroke Rehabilitation: Comparing Institutional Long-Term Care Settings

VA 中风后康复：比较机构长期护理设置

• 批准号: 8483019
• 负责人: Huanguang Jia
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8483019
• 关键词: Acute; Address; Admission activity; Age; Antidepressive Agents; Articular Range of Motion; Attitude; Bed Occupancy; Beds; Behavior Disorders; Braces-Orthopedic appliances; Caring; Case Mixes; Categories; Characteristics; Chronic; Communication; Communities; Comorbidity; Contracts; Data; Data Set; Databases; Decision Making; Deglutition; Diagnosis; Discipline of Nursing; Eating; Education; Enabling Factors; Ethnic Origin; Funding; Future; Gender; Goals; Grooming; Healthcare; Hospitals; Intervention; Length of Stay; Link; Logistic Regressions; Logit Models; Long-Term Care; Marital Status; Medical; Mental Depression; Meta-Analysis; Methods; Modeling; Moods; Nursing Homes; Occupational Therapy; Outcome; Outcome Measure; Ownership; Patients; Persons; Pharmaceutical Preparations; Physical Function; Physical therapy; Policy Maker; Predisposing Factor; Process; Quality of Care; Race; Recovery; Rehabilitation therapy; Research; Respiratory Therapy; Retrospective Studies; Risk; Rural; Services; Source; Speech Therapy; Speed; Splint Device; Sterile coverings; Stroke; Structure; Variant; Veterans; Walking; base; cognitive function; community living; comparative; cost; disability; evidence base; functional disability; health care service utilization; meetings; mortality; post stroke; programs; psychologic; rehabilitation service; residence; response; statistics; stroke rehabilitation

DESCRIPTION (provided by applicant): Background: Each year, approximately 3,900 and 14,100 Veterans reside in VA community living centers (CLCs) and VA per diem contracted community nursing homes (CNHs) for post-stroke care, respectively. A growing body of evidence shows that when effective rehabilitation interventions are continued post-stroke, they can speed patient recovery processes and minimize patient functional disabilities and deficits. Although VA has funded studies examining the structure, process and outcomes of rehabilitation services received by Veterans in CLCs and/or CNHs, these studies have focused on CLCs alone or on CLCs and CNHs within a single state. To better understand the quality of care received by Veteran residents of different types of nursing facilities, further research is needed on the adjusted quality outcomes and geographical variations among Veterans with the same medical condition who reside in CLCs or CNHs. Objectives: The goals of this study are to examine institutional long-term rehabilitation care and to assess the quality and geographical variations of rehabilitation services received by VA stroke residents in CLCs versus VA stroke residents in CNHs. The three specific aims are: (1) to compare the differences in nursing home and VA stroke resident characteristics between CLCs and CNHs nationally and by Veterans Integrated Service Network (VISN); (2) to examine the differences in rehabilitation care, restorative care, and mood-behavioral disorder care received by the residents between CLCs and CNHs nationally and by VISN; and (3) to evaluate the differences of VA stroke residents in physical function, cognitive function, depression status, 12-month mortality and stroke rehospitalization between CLCs and CNHs nationally and by VISN. The long-term objectives are to systematically examine multiple-source long-term rehabilitation care; determine geographical variations in rehabilitation care; examine the comparative costs of rehabilitation care; and develop an integrated long-term rehabilitation care and outcome database for VA stroke patients. Methods: This retrospective study includes all VA residents who were diagnosed with stroke and newly admitted to CLCs or CNHs from January 1, 2006 to December 31, 2009, regardless of their race/ethnicity, gender, and age. CLC and CNH Minimum Data Sets (MDS) will be linked with different VA datasets to define residents' stroke diagnoses and obtain the data needed for the study. For Objective 1, descriptive statistics will be obtained on all variables and comparisons of facility and resident characteristics will be conducted between CLCs and CNHs nationally and by VISN. For Objective 2, Poisson regression or two-part model of health services utilization will be used to analyze rehabilitation and restorative services; cumulative logit model will be applied to assess the ordered response of mood-behavioral disorder care. For Objective 3, we will assess the differences between CLCs and CNHs in the ADL function, cognitive function and depression change from admission to 3-, 6- and 9-month and combine the evidence to assess the overall difference using meta-analysis method. Logistic regression for mortality and Poisson regression for the number of stroke rehospitalizations will be fitted. Objective 2 and 3 analyses will be case-mix risk-adjusted; national and VISN comparisons will be made between the residents in CLCs and CNHs. Significance: Quality and geographical variations in services for Veterans are of the highest importance since stroke is prevalent among VA patients. CLCs and CNHs are two major sources of long-term care for Veterans, and VA continues to expand its long-term programs to meet the increasing needs of Veterans with chronic disabilities. The study addresses two of HSR&D's funding priority categories: long-term care and healthcare access. Findings from the study are important for VA policy makers, clinicians, and Veterans, and will enable them make future decisions regarding the appropriate placement of Veterans in rehabilitation facilities for post- stroke care. The study will provide evidence-based information about the quality and geographical variations in post-stroke, institutional long-term rehabilitatio care among Veteran residents in CLCs and CNHs.

描述（由申请人提供）： 背景资料：每年，大约有3,900和14,100名退伍军人分别居住在VA社区生活中心（CLC）和VA每日签约社区疗养院（CNH）进行中风后护理。 越来越多的证据表明，当中风后继续进行有效的康复干预时，它们可以加速患者的康复过程，并最大限度地减少患者的功能障碍和缺陷。 尽管退伍军人管理局资助了一些研究，检查退伍军人在CLC和/或CNH中接受的康复服务的结构、过程和结果，但这些研究的重点是单独的CLC或单个州内的CLC和CNH。 为了更好地了解不同类型护理设施的退伍军人居民所接受的护理质量，需要进一步研究居住在CLC或CNH的具有相同医疗条件的退伍军人之间的调整后的质量结果和地理差异。 目的：本研究的目的是检查机构的长期康复护理和评估的质量和地理差异的康复服务，VA中风居民在CLC与VA中风居民在CNH。 三个具体目标是：（1）比较全国CLC和CNH与退伍军人综合服务网络（VISN）在疗养院和VA卒中住院患者特征方面的差异：（2）比较全国CLC和CNH与VISN在康复护理、恢复性护理和情绪行为障碍护理方面的差异;（3）评估VA卒中居民在躯体功能、认知功能、抑郁状况 12-月死亡率和中风再住院之间的CLC和CNH全国和VISN。 长期目标是系统地检查多源长期康复护理;确定康复护理的地理差异;检查康复护理的比较成本;并为VA卒中患者开发综合长期康复护理和结局数据库。 研究方法：这项回顾性研究包括2006年1月1日至2009年12月31日期间被诊断为中风并新入住CLC或CNH的所有VA居民，无论其种族/民族、性别和年龄如何。 CLC和CNH最小数据集（MDS）将与不同的VA数据集相关联，以定义居民的卒中诊断并获得研究所需的数据。 对于目标1，将获得所有变量的描述性统计数据，并将在全国范围内和通过VISN在CLC和CNH之间进行设施和居民特征的比较。 对于目标2，Poisson回归或卫生服务利用的两部分模型将用于分析康复和恢复性服务;累积logit模型将用于评估情绪行为障碍护理的有序反应。 目标3：评估CLC和CNH在入院至3、6、9个月的ADL功能、认知功能和抑郁变化方面的差异，并采用Meta分析方法结合联合收割机证据评估总体差异。 将拟合死亡率的Logistic回归和卒中再住院次数的Poisson回归。 目标2和目标3分析将进行病例组合风险调整;将在CLC和CNH的居民之间进行国家和VISN比较。 意义：退伍军人服务的质量和地理差异是最重要的，因为中风在VA患者中很普遍。 CLC和CNH是退伍军人长期护理的两个主要来源，VA继续扩大其长期计划，以满足慢性残疾退伍军人日益增长的需求。 该研究涉及HSR & D的两个资金优先类别：长期护理和医疗保健服务。 该研究的结果对退伍军人事务部的政策制定者、临床医生和退伍军人来说都很重要，并将使他们能够在未来决定将退伍军人适当安置在中风后护理的康复设施中。 该研究将提供基于证据的信息 关于CLC和CNH的退伍军人住院医师中卒中后机构长期康复护理的质量和地理差异。