长期急性护理医院关闭后的患者结果
Anica C Law1,2, Nicholas A Bosch1, Yang Song2
1The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
JAMA network open
|November 21, 2023
概括
长期急症护理医院 (LTCH) 的关闭影响了机械呼吸 (MV) 患者的出院模式和气管切除术患者的高级指令决策,但没有影响死亡率.
科学领域:
- 医疗保健政策 医疗保健政策
- 在急性病后的护理.
- 呼吸系统药物 呼吸系统药物
背景情况:
- 长期急症护理医院 (LTCH) 对需要机械通风 (MV) 的患者至关重要.
- 联邦支付改革导致美国LTCH关闭.
- 这些关闭对患者护理和结果的影响仍然不清楚.
研究的目的:
- 评估LTCH关闭与短期住院护理模式之间的关联.
- 评估LTCH关闭对那些需要长期MV的患者结果的影响.
主要方法:
- 用差异差异分析进行回顾性,全国性,匹配的队列研究.
- 利用了2011-2019年的Medicare数据,用于66岁以上接受MV≥96小时的患者.
- 在依赖于关闭的LTCH的短期住院的结果与对照医院的结果进行了比较.
主要成果:
- LTCH关闭与LTCH转移率降低和每天活费支出降低相关.
- 在气管切除术患者中,关闭与增加的"不要复苏"命令和熟练护理机构转移有关.
- 在LTCH关闭和90天死亡率之间没有发现显著的关联.
结论:
- 关闭LTCH改变了出院的做法,并影响了弱势患者的终身护理决策.
- 在这项研究中,死亡率没有受到LTCH关闭的显著影响.
- 需要进一步研究功能结果和患者/家庭满意度.
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