更多总是更好的吗? 在熟练护理机构的经济动机治疗和患者结果
Rachel A Prusynski1, Bianca K Frogner2, Sean D Rundell3
1Department of Rehabilitation Medicine, University of Washington, Seattle WA; Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle WA.
Archives of physical medicine and rehabilitation
|August 4, 2023
概括
在熟练护理设施 (SNFs) 中,有经济动机的治疗或门与更好的患者功能和社区出院有关. 在接受较低治疗量患者中,这种效应更为明显,这突出了对康复服务的政策影响.
科学领域:
- 老年学是一门学科.
- 医疗保健服务研究 医疗服务研究
- 康复医学 康复医学 康复医学
背景情况:
- 熟练护理设施 (SNFs) 在急性后护理中发挥着至关重要的作用.
- 了解治疗提供对患者结果的影响对于质量改善至关重要.
- 医疗保健机构的经济动机的做法需要对其对患者福祉的影响进行调查.
研究的目的:
- 调查经济动机治疗 (门) 与SNF患者治疗结果之间的关联.
- 为了确定是否门,定义为治疗提供在10分钟内超出偿还门,影响功能改善和社区排放.
- 探索治疗量如何调节值和患者结果之间的关系.
主要方法:
- 一项使用2018年医疗保险行政数据的队列研究.
- 美国13949个SNF的934,677名医疗保险A部分患者的分析.
- 使用混合效应模型来评估值和结果之间的关系,并根据相关的共同变量进行调整.
主要成果:
- 门与功能改善 (OR 1.07) 和社区出院 (OR 1.03) 上的一小部分积极影响有关.
- 功能改善的效果大小在不同的治疗量中是一致的.
- 接受较低量的治疗的患者在应用值时 (OR 1.27) 显示了社区出院的最大效果大小.
结论:
- 在SNF中接受值治疗的患者表现出略有改善的功能和更高的社区出院率.
- 门对社区出院的积极影响尤其明显在接受较低量治疗的患者中.
- 调查结果强调了医疗保险支付政策的重要性,这些政策支持,而不是阻碍,在SNFs潜在的有益的康复服务.
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