Hospital Readmission and Inpatient Medical Rehabilitation

再入院和住院医疗康复

• 批准号: 8505516
• 负责人: KENNETH J. OTTENBACHER
• 金额: $ 30.59万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-05 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8505516
• 关键词: Accountability; Acute; Address; Age; Attention; Bladder Control; Caring; Categories; Catheters; Characteristics; Clinical; Congresses; Data; Data Analyses; Data Set; Decubitus ulcer; Elderly; Event; Finches; Fracture; Future; Goals; Health Care Costs; Health Care Quality Indicators; Healthcare; Hip Fractures; Hip region structure; Hospitalization; Hospitals; Impairment; Incidence; Information Systems; Inpatients; Interdisciplinary Study; Intestines; Investigation; Limb structure; Lower Extremity; Lower Extremity Fracture; Medicare; Outcome; Patient Discharge; Patients; Persons; Population; Quality Indicator; Records; Rehabilitation Outcome; Rehabilitation therapy; Replacement Arthroplasty; Research; Research Support; Resource Allocation; Resources; Rewards; Risk; Services; Stroke; Survival Analysis; Time; Traumatic Brain Injury; United States Centers for Medicare and Medicaid Services; Urinary Incontinence; clinical decision-making; cost; disability; experience; high risk; hospital readmission; nervous system disorder; payment; predictive modeling; programs; prospective; public health relevance; quality assurance; rehabilitation service; statistics; success

DESCRIPTION (provided by applicant): The Patient Protection and Affordable Care Act creates a "hospital readmission reduction program" to help acute care hospitals decrease avoidable rehospitalizations. Research suggests approximately twenty percent of all Medicare patients are rehospitalized within 30 days of discharge from acute care and that the majority of these rehospitalizations are preventable. Research examining rehospitalization has focused primarily on patients discharged from acute care hospitals. We will examine rates and reasons for hospital readmission in high volume and high cost patients, such as those with stroke or hip fracture, who receive inpatient medical rehabilitation. This is an understudied population with important implications for health care resources and costs as the U.S. population continues to age. Our goal is to determine rates and factors associated with hospital readmissions in persons receiving inpatient rehabilitation services for the six largest rehabilitation impairment groups as defined by the Centers for Medicare and Medicaid Services (CMS). We propose the following Specific Aims: Aim 1. Examine national data from the Centers for Medicare and Medicaid Services and the Uniform Data System for Medical Rehabilitation (UDSMR) to determine rates of hospital readmission for the six largest impairment groups receiving inpatient medical rehabilitation in the U.S. (stroke, fracture of the lower extremity, joint replacement of the lowe extremity, debility, neurological disorders and traumatic brain injury) (MedPAC, 2011). Aim 2. Determine patient characteristics (sociodemographic and clinical/functional) associated with hospital readmission across the six impairment groups (see Aim 1). We will examine data from the Centers for Medicare and Medicaid Services files and the Uniform Data System for Medical Rehabilitation dataset for the years 2006 - 2010 (~ 1.3 million patient records). We will use exploratory data analysis and descriptive statistics to determine the rate of hospital readmission for the six rehabilitation impairment categories. Time-to-event survival analyses will be used to examine personal and clinical factors associated with hospital readmission during the first 90 days after discharge. Our interdisciplinary research team has twenty years of experience using large national datasets to study rehabilitation outcomes. The findings will address priorities of the Affordable Care Act, provide information useful in developing future predictive models, and assist in documenting hospital accountability and establishing quality indicators.

描述（由申请人提供）：患者保护和平价医疗法案创建了一个“医院再入院减少计划”，以帮助急性护理医院减少可避免的再住院。研究表明，大约20%的医疗保险患者在出院后30天内再次住院，其中大多数再次住院是可以预防的。调查再住院的研究主要集中在急性护理医院出院的患者。我们将研究高容量和高费用患者的再入院率和原因，例如接受住院医疗康复的中风或髋部骨折患者。这是一个未充分研究的人群，随着美国人口的不断老龄化，这对医疗保健资源和成本具有重要影响。我们的目标是确定六个最大的康复障碍组接受住院康复服务的患者的再入院率和相关因素， 由医疗保险和医疗补助服务中心（CMS）定义。我们提出以下具体目标：目标1。检查来自医疗保险和医疗补助服务中心以及医疗康复统一数据系统（UDSMR）的国家数据，以确定美国接受住院医疗康复的六个最大障碍群体的再入院率。（中风、下肢骨折、下肢关节置换术、虚弱、神经系统疾病和创伤性脑损伤）（MedPAC，2011）。目标2.确定六个损伤组中与再入院相关的患者特征（社会人口统计学和临床/功能）（见目标1）。我们将检查2006 - 2010年医疗保险和医疗补助服务中心文件和医疗康复统一数据系统数据集的数据（约130万例患者记录）。我们将使用探索性数据分析和描述性统计来确定六种康复障碍类别的再入院率。将使用至事件发生时间生存分析来检查出院后前90天内与再入院相关的个人和临床因素。我们的跨学科研究团队拥有20年使用大型国家数据集研究康复结果的经验。调查结果将解决负担得起的医疗法案的优先事项，提供有用的信息，在开发未来的预测模型，并协助记录医院的问责制和建立质量指标。