National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD 20892, USA.
Arch Phys Med Rehabil. 2013 Apr;94(4):622-9. doi: 10.1016/j.apmr.2012.09.033. Epub 2012 Nov 1.
To determine the impact of postacute care site on stroke outcomes.
Prospective cohort study.
Four northern California hospitals that are part of a single health maintenance organization.
Patients with stroke (N=222) enrolled between February 2008 and July 2010.
Not applicable.
Baseline and 6-month assessments were performed using the Activity Measure for Post Acute Care (AM-PAC), a test of self-reported function in 3 domains: Basic Mobility, Daily Activities, and Applied Cognition.
Of the 222 patients analyzed, 36% went home with no treatment, 22% received home health/outpatient care, 30% included an inpatient rehabilitation facility (IRF) in their care trajectory, and 13% included a skilled nursing facility (but not IRF) in their care trajectory. At 6 months, after controlling for important variables such as age, functional status at acute care discharge, and total hours of rehabilitation, patients who went to an IRF had functional scores that were at least 8 points higher (twice the minimally detectable change for the AM-PAC) than those who went to a skilled nursing facility in all 3 domains and in 2 of 3 functional domains compared with those who received home health/outpatient care.
Patients with stroke may make more functional gains if their postacute care includes an IRF. This finding may have important implications as postacute care delivery is reshaped through health care reform.
确定急性后期护理场所对中风结果的影响。
前瞻性队列研究。
四家位于加利福尼亚北部的医院，它们是单一健康维护组织的一部分。
2008 年 2 月至 2010 年 7 月期间纳入的中风患者（N=222）。
不适用。
使用急性后期护理活动量表（AM-PAC）进行基线和 6 个月评估，该量表测试 3 个领域的自我报告功能：基本移动能力、日常活动和应用认知。
在分析的 222 名患者中，36%的患者未接受任何治疗即回家，22%的患者接受家庭健康/门诊护理，30%的患者在护理过程中包括住院康复机构（IRF），13%的患者在护理过程中包括熟练护理机构（但不包括 IRF）。在控制年龄、急性护理出院时的功能状态和康复总时间等重要变量后，在所有 3 个领域和 3 个功能领域中的 2 个领域中，前往 IRF 的患者的功能评分比前往熟练护理机构的患者至少高 8 分（AM-PAC 的最小可检测变化的两倍），与接受家庭健康/门诊护理的患者相比。
如果中风患者的急性后期护理包括 IRF，他们可能会获得更多的功能增益。随着医疗保健改革重塑急性后期护理的提供，这一发现可能具有重要意义。
