随着时间的推移,熟练护理机构患者的疾病严重程度不断增加:对再接收处罚的影响
David Siskind1, Tarayn Dhansew2, Amira Burns3
1Stern Family Center for Rehabilitation, Division of Geriatrics and Palliative Medicine, Zucker School of Medicine, Manhasset, New York, USA.
Journal of the American Geriatrics Society
|October 24, 2023
概括
熟练的护理机构患者越来越复杂,导致再接收风险更高. 目前的财政处罚可能需要使用经过验证的风险工具进行重新评估,以准确评估患者的敏性.
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
- 临床信息学 临床信息学
背景情况:
- 对于熟练护理机构 (SNFs) 的经济处罚是基于过时的再接收数据.
- 由于老龄化和严重疾病,SNF中的患者人群越来越复杂.
- 目前的指标可能不准确地反映出不断变化的患者敏度和再接收风险.
研究的目的:
- 评估SNF患者患者急性和30天住院再入院风险的趋势.
- 评估当前风险调整模型是否适用于SNF的财务处罚.
- 确定是否经过验证的再接收风险评估工具可以更准确地衡量患者的严重程度.
主要方法:
- 追溯分析了2010-2019年期间21591个SNF入院和退院的情况.
- 提取了患者数据,包括人口统计,LACE指数,查尔森并发症指数 (CCI) 和简化的HOSPITAL得分.
- 计算了风险得分和确定了30天的再入院.
主要成果:
- 从2010年到2019年,LACE,CCI和HOSPITAL指数的年平均分数呈现出稳定的增长.
- 在CCI,LACE和HOSPITAL的不同分数范围内,估计的再接收概率有很大差异.
- 增加患者的疾病敏度与30天再入院的风险更高相关.
结论:
- 患者的疾病急性逐渐增加,与更高的30天再入院风险相关联.
- 在SNF基于价值的采购计划中的当前风险调整可能是不准确的.
- 经过临床验证的再接收风险工具可以更准确地反映患者的重症程度,以便进行支付调整.
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