在严重创伤伤害后的住院康复中出院的州级变化
Alexander J Ordoobadi1, Kimberly K Greenberg, Gracyn Campbell
1From the Center for Surgery and Public Health, Department of Surgery (A.J.O., S.I., J.S.W., A.S., M.P.J.), Brigham and Women's Hospital; The Gillian Reny Stepping Strong Center for Trauma Innovation (A.J.O., A.S., M.P.J.), Brigham and Women's Hospital; Spaulding Rehabilitation, Mass General Brigham (K.K.G., J.C.S.); Harvard Medical School (G.C.); Department of Physical Medicine and Rehabilitation (J.C.S.), Harvard Medical School, Boston, Massachusetts; Division of Trauma and Acute Care Surgery, Department of Surgery (Z.G.H.), University of Alabama at Birmingham, Birmingham, Alabama; Department of Emergency Medicine (C.N.), Oregon Health & Science University, Portland, Oregon; and Division of Trauma and Acute Care Surgery (A.S.), Mass General Brigham, Boston, Massachusetts.
严重受伤的患者在进入住院康复设施 (IRFs) 方面表现出明显的州差异. 增加IRF供应可能会改善获得专门创伤康复护理的机会.
科学领域:
- 创伤外科手术是什么
- 康复医学是康复的医学.
- 医疗服务研究 医疗服务研究
背景情况:
- 住院康复设施 (IRF) 改善严重受伤患者的长期功能独立性.
- 美国各州对IRF的排放模式有很大差异.
- 了解区域供应和获取差异对于优化创伤后护理至关重要.
研究的目的:
- 检查严重受伤患者IRF出院率的州级变化.
- 评估IRF的区域供应和IRF放电的可能性之间的关联.
- 确定获得专业康复护理的潜在差异.
主要方法:
- 对2021年医疗保健成本和利用项目的回顾性分析 13个州的州住院患者数据库.
- 包括严重受伤 (ISS>15) 的成年患者生存到出院.
- 多项式和混合效应物流回归模型分析排放概率和IRF供应关联,控制混因素.
主要成果:
- 在104,017名严重受伤的患者中,有13%的患者被送往IRF.
- 调整后的IRF排放概率从俄勒冈州的6.4%到肯塔基州的22.1%不等.
- 每百万人口的每一个额外的IRF增加了11%的IRF排放的几率 (p=0.024).
结论:
- 在获得严重受伤患者的IRF护理方面,国家层面存在显著的差异.
- 在服务不足的州增加IRF的可用性可以提高获得专业康复的机会.
- 解决区域供应问题可能会改善公平的创伤后护理结果.
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