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：每年，约有3,900和14,100名退伍军人分别居住在弗吉尼亚州社区生活中心（CLC）和Diem Contracted Community Community Nursing Homes（CNHS），分别用于冲程后护理。 越来越多的证据表明，当中风后继续进行有效的康复干预措施时，它们可以加快患者康复过程并最大程度地减少患者的功能障碍和缺陷。 尽管VA资助了资深退伍军人在CLC和/或CNHS中获得的康复服务的结构，过程和结果的研究，但这些研究集中在单独的CLC或单个状态下的CLC和CNHS上。 为了更好地了解不同类型护理设施的资深居民获得的护理质量，需要对具有相同医学状况的退伍军人的调整质量结果和地理变化进行进一步的研究，该质量与CLC或CNH相同。 目的：这项研究的目标是检查机构长期的康复护理，并评估VA中风居民在CLCS中与CNHS中VA中风居民收到的康复服务的质量和地理变化。 这三个具体目的是：（1）比较全国范围内CLC和CNHS和退伍军人综合服务网络（VISN）的疗养院和VA中风居民特征的差异； （2）检查CLCS和CNHS之间以及VISN的居民在康复护理，恢复性护理以及情绪行为障碍护理方面的差异； （3）评估VA中风居民在身体机能，认知功能，抑郁状态， CLC和CNHS与VISN之间的12个月死亡率和中风重新搬迁。 长期目标是系统地检查多种源的长期康复护理；确定康复护理中的地理变化；检查康复护理的比较成本；并为VA中风患者开发综合的长期康复护理和结果数据库。 方法：这项回顾性研究包括所有被诊断出患有中风的VA居民，并从2006年1月1日至2009年12月31日被诊断为CLC或CNHS，无论其种族/种族，性别，性别和年龄如何。 CLC和CNH最小数据集（MDS）将与不同的VA数据集链接，以定义居民的中风诊断并获取研究所需的数据。 对于目标1，将在所有变量上获得描述性统计数据，并且将在全国和VISN之间进行所有设施和居民特征的比较。 对于目标2，将使用泊松回归或卫生服务利用的两部分模型来分析康复和恢复服务；累积logit模型将用于评估情绪行为障碍护理的有序响应。 对于目标3，我们将评估ADL功能中CLC和CNHS之间的差异，认知功能和抑郁症从入院变为3个，6和9个月，并结合证据以使用荟萃分析方法评估总体差异。 将安装死亡率和泊松回归的逻辑回归。 目标2和3分析将由病例混合风险调整； CLC和CNHS的居民将进行国家和VISN比较。 意义：退伍军人服务的质量和地理差异非常重要，因为VA患者中风普遍存在。 CLC和CNHS是对退伍军人的长期护理的两个主要来源，VA继续扩大其长期计划，以满足退伍军人不断增长的慢性残疾需求。 该研究介绍了HSR＆D的两个优先类别：长期护理和医疗保健访问。 这项研究的发现对VA政策制定者，临床医生和退伍军人非常重要，并将使他们能够做出有关在康复后的康复设施中适当安置的未来决定。 该研究将提供基于证据的信息 关于CLC和CNH的退伍军人居民的中风后，机构长期康复护理的质量和地理变化。