冠状动脉旁路移植后熟练护理设施使用的决定因素和结果:全州的经验
Michael P Thompson1,2, James W Stewart1, Hechuan Hou1
1Departments of Cardiac Surgery (M.P.T., J.W.S., H.H., F.D.P., R.L.P., R.B.H., D.S.L. A.D.), Michigan Medicine, Ann Arbor.
Circulation. Cardiovascular quality and outcomes
|September 13, 2023
概括
在冠状动脉旁路移植后,熟练护理机构 (SNF) 的护理是常见的,但与患者的治疗结果更差和死亡率更高有关. 标准化SNF使用标准可以提高护理的适当性,减少医院的变化.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 老年医学 老年医学
背景情况:
- 心脏手术后使用熟练护理设施 (SNF) 很普遍,但了解得很少.
- 在隔离冠状动脉旁路移植 (CABG) 后SNF使用的模式和决定因素需要调查.
研究的目的:
- 为了评估SNF使用的决定因素,在单独的CABG之后.
- 评估与这种患者群体中SNF利用相关的短期和长期结果.
主要方法:
- 与STS数据 (2011-2019) 相关的Medicare FFS索赔的回顾性分析.
- 包括在密歇根州之前没有使用SNF的孤立CABG患者.
- 多变量混合效应回归分析了SNF使用的决定因素和结果.
主要成果:
- SNF使用率为22.3% (1920/8614名患者),在各医院 (3.2%-58.3%) 中具有很高的变化.
- SNF使用者年龄较大,更常见的是女性,非白人,具有更多的并发症和更长的住院时间.
- 使用SNF与增加90天再入院,急救诊所访问和更高的风险调整死亡率相关 (HR 1.41).
结论:
- 在隔离 CABG 后的 SNF 护理是频繁的,可变的,并且与风险调整后的较差结果相关.
- 与非使用者相比,在SNF用户中观察到较高的死亡率.
- 标准化SNF入院标准可以提高适当性,减少医院间的变化.
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