Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
PM R. 2013 May;5(5):408-17. doi: 10.1016/j.pmrj.2012.09.578. Epub 2012 Nov 14.
To determine the patient-, treatment-, and facility-level factors that are associated with home discharge among male veterans with lower extremity amputation who received inpatient rehabilitation after surgery.
A retrospective observational study.
Veterans Affairs Medical Centers.
This study included 1480 male veterans.
Generalized estimating equation models were used to model the likelihood of home discharge to account for within-facility clustering. We reported odds ratios (ORs) and 95% confidence intervals (95% CIs).
Discharged to home.
There were a total of 1163 (78.6%) veterans who were discharged home after the surgical hospitalization, compared with other locations. Patients who were married were more likely to be discharged home compared with patients who were not married (OR = 1.51, 95% CI = 1.14-1.99, P < .01). Compared with being transferred from another hospital or extended care, patients who were admitted from home were far more likely to be discharged home (OR = 8.43, 95% CI = 5.48-12.96, P < .0001). Patients with evidence of local significant infection were less likely to be discharged home (OR = 0.57, 95% CI = 0.39-0.83, P < .01), as were patients with evidence of congestive heart failure (OR = 0.62, 95% CI = 0.45-0.85, P < .01) or depression (OR = 0.63, 95% CI = 0.40-0.98, P = .04). Veterans with greater discharge motor Functional Independence Measure scores were more likely to be discharged home (OR = 1.23, 95% CI = 1.16-1.31 per 10-point increase in discharge Functional Independence Measure motor score, P < .0001). Conversely, patients undergoing procedures for ongoing active cardiac pathology were less likely to be discharged home (OR = 0.55, 95% CI = 0.37-0.81, P < .01).
This study showed a strong association between the sociological factors of marital status and living location before hospitalization and home discharge. The significance of discharge functional status highlights the importance of addressing the expected care burden once patients are discharged home.
确定与接受术后住院康复的下肢截肢男性退伍军人出院回家相关的患者、治疗和设施水平因素。
回顾性观察研究。
退伍军人事务医疗中心。
这项研究包括 1480 名男性退伍军人。
使用广义估计方程模型来模拟出院回家的可能性，以说明设施内的聚类。我们报告了优势比（OR）和 95%置信区间（95%CI）。
出院回家。
与其他地点相比，共有 1163 名（78.6%）退伍军人在手术后的住院治疗后出院回家。已婚患者出院回家的可能性高于未婚患者（OR=1.51，95%CI=1.14-1.99，P<.01）。与从其他医院或长期护理机构转来的患者相比，从家中入院的患者更有可能出院回家（OR=8.43，95%CI=5.48-12.96，P<.0001）。有局部明显感染证据的患者出院回家的可能性较低（OR=0.57，95%CI=0.39-0.83，P<.01），有充血性心力衰竭证据的患者（OR=0.62，95%CI=0.45-0.85，P<.01）或抑郁症证据的患者（OR=0.63，95%CI=0.40-0.98，P=.04）出院回家的可能性较低。出院运动功能独立性测量评分较高的退伍军人更有可能出院回家（OR=1.23，95%CI=每增加 10 分出院功能独立性测量运动评分增加 1.16-1.31，P<.0001）。相反，正在进行持续活动性心脏病理过程的患者出院回家的可能性较低（OR=0.55，95%CI=0.37-0.81，P<.01）。
这项研究表明，婚姻状况和住院前居住地点等社会学因素与出院回家之间存在很强的关联。出院功能状态的重要性突出了患者出院回家后应对预期护理负担的重要性。
