在熟练护理机构的患者功能结果:衰退治疗的调解作用
Rachel A Prusynski1, Andrew Humbert2, Harsha Amaravadi3
1Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Health Systems and Population Health, University of Washington, Seattle, WA.
在患者驱动支付模式 (PDPM) 和COVID-19期间,熟练护理设施 (SNF) 治疗数分钟的减少显著恶化了患者的功能结果,治疗下降调解了这些负面变化.
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
- 康复医学 康复医学 康复医学
背景情况:
- 熟练的护理设施 (SNFs) 提供急性后护理,其功能结果对患者康复至关重要.
- 患者驱动支付模式 (PDPM) 和COVID-19大流行大大改变了SNF的运作,包括治疗的交付.
研究的目的:
- 评估SNF患者在PDPM后和COVID-19期间减少治疗时间对功能结果的影响.
- 为了确定治疗时间减少是否会改变患者的功能结果.
主要方法:
- 从2018年1月到2021年9月,回顾性队列研究分析了Medicare服务费SNF患者 (N=3,534,928) 的情况.
- 调解分析检查了每天平均治疗时间 (MTD) 和功能结果 (日常生活活动 - ADL分数) 之间的关系.
- 根据患者,设施和社区层面的混因素进行调整.
主要成果:
- 平均MTD从PDPM前的122.2降至COVID-19期间的87.7,平均MTD从PDPM前的122.2降至COVID-19.
- 在PDPM后,ADL下降的概率增加了1.7个百分点,在COVID-19期间增加了3.7个百分点,MTD下降分别占这些增加的47.9%和26.5%.
- 高ADL改善概率在PDPM后和COVID-19期间增加,但MTD下降对这些改善产生了负面影响.
结论:
- 在PDPM实施后和COVID-19大流行期间,SNF治疗分钟的减少大大影响了患者的功能结果恶化.
- 在SNF中优化治疗提供对于增强患者功能恢复至关重要.
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