在熟练护理设施的急性后护理中 Delirium 的持续性
Chan Mi Park1,2, Sandra Shi1,2, Richard N Jones3
1Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
JAMA network open
|March 17, 2025
概括
改善医疗保险急性护理后转型法案 (IMPACT) 导致在熟练护理机构 (SNF) 入院时的妄想减少,并改善妄想解决. 然而,持续的妄想仍然是一个问题,需要改进SNF管理策略.
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
- 改善临床质量 改善临床质量
背景情况:
- 2014年"改善医疗保险急性后护理转型法案" (IMPACT) 要求提高急性后护理的质量.
- 痴呆症是急性后护理环境中的关键质量指标,显著影响患者的治疗结果.
研究的目的:
- 评估2014年至2019年间熟练护理机构 (SNFs) 痴呆症持续性和解决的变化.
- 评估"IMPACT法案"对国家自然资源基金内的痴呆症管理的影响.
主要方法:
- 一项横截面研究分析了2014年和2019年SNF入院的5%医疗保险样本.
- 用最小数据集 (MDS) 混评估方法评估狂妄症.
- 多项逻辑回归调整为患者和设施因素,以比较妄想结果.
主要成果:
- 在SNF入院时妄的患病率从2014年的4.3%下降到2019年的2.5%.
- 调整后的持续性妄想从62.3%降至54.7%,而妄想解脱率在2014年至2019年间从29.1%增加到37.4%.
- 尽管情况有所改善,但在2019年观察到持续狂妄症的高率.
结论:
- 影响法案与SNF入院时妄症的减少和解决率的提高有关.
- 持续的妄想仍然是SNF的重大挑战,表明需要加强管理策略.
- 需要进一步的研究和干预,以优化后急性设置中的妄想治疗.
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