在医疗保险受益人中全关节整形术后后急性护理中的身体和认知功能趋势:2013-2018年
Nikhil Ailaney1, Meiling Ying2, Benjamin F Ricciardi1
1Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA.
Journal of the American Medical Directors Association
|August 29, 2024
概括
在全关节整形术 (TJA) 后出院的医疗保险受益人越来越多地前往家庭卫生机构 (HHAs),HHA和住院康复设施 (IRF) 患者随着时间的推移表现出更大的身体和认知依赖. 熟练护理机构 (SNF) 的患者变得不那么依赖.
科学领域:
- 整形外科 整形外科 整形外科
- 老年医学 老年医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在全关节整形术 (TJA) 后,急性关节后护理需求有很大差异.
- 了解不同出院目的地的患者功能状态对于护理规划至关重要.
- 对于TJA后的Medicare受益人的身体和认知功能趋势尚未被全面评估.
研究的目的:
- 检查Medicare受益者在TJA后退院到熟练护理设施 (SNF),住院康复设施 (IRF) 和家庭与家庭健康机构 (HHA) 的身体和认知功能趋势.
- 分析2013年至2018年间在这些急性后护理环境中患者特征的变化.
主要方法:
- 使用2013-2018年医疗保险入学,索赔和评估数据的观察性研究.
- 对1,278,939名Medicare受益人的分析,这些受益人接受了TJA并被释放到SNF,HHA或IRF.
- 多变量模型评估了出院目的地与患者身体 (日常生活活动) 和认知状态之间的关联,控制共变量.
主要成果:
- 对SNF和IRF的排放减少,而对HHA的排放从2013年到2018年显著增加 (P < .001).
- 随着时间的推移,SNF患者的身体和认知依赖性下降.
- HHA和IRF患者表现出增加的身体和认知依赖,表明更大的护理需求.
结论:
- 该研究观察到2013年至2018年期间TJA后排放模式向HHA显著转变.
- 虽然SNF患者表现出功能状况的改善,但那些被送往HHA和IRF的患者在身体和认知上变得更受损.
- 医疗保健政策和财政支持是需要解决这些后急性护理设置患者的不断变化的数量和临床强度.
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