Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Department of Innovation and Development, Evean, Purmerend, The Netherlands.
J Am Med Dir Assoc. 2013 Oct;14(10):731-5. doi: 10.1016/j.jamda.2013.04.003. Epub 2013 May 20.
Although geriatric rehabilitation (GR) is beneficial for restoration of activities and participation after hospitalization of vulnerable older persons, little is known about the optimal organization of care of these postacute facilities. This study examines the relationship of patient volume and service concentration with successful GR (short length of stay and discharge home) in skilled nursing facilities (SNFs).
A national multicenter retrospective cohort study.
All patients indicated for GR in a Dutch SNF.
Nurses filled out digital registration forms from patient records. Patients were studied in 3 predefined diagnostic groups: total joint replacement, traumatic injuries, and stroke. Facility characteristics were obtained by structured telephone interviews with facility managers. Volume was based on the number of discharges in a 3-month period and categorized in low-, medium-, and high-volume facilities. Concentration was defined at the organizational level in which the population consists of 80% or more of 1 or 2 diagnostic groups, with the prerequisite of having a minimum of 10 rehabilitation beds.
From 88 facilities, 2269 GR patients (mean age 78.2 years [SD 9.7]; 68.2% female) were included. The median length of stay in the SNF was 45 days (interquartile range 23-81), 57% of the patients were discharged home, and 9.8% died during GR. Of patients with total joint replacement (n = 501), concentration was related to successful rehabilitation (odds ratio 5.7; 95% confidence interval 1.3-24.3; P = .020, adjusted for age and gender); this relationship was not found for patients with traumatic injuries or stroke. Volume showed no relation with successful rehabilitation in any of the 3 diagnostic groups.
This study may indicate that concentration in an SNF, as a proxy for specialization, favors successful GR in total joint replacement. This relationship was not found for the traumatic injuries or stroke groups, or for volume. The relation on functional outcome in GR needs further investigation.
尽管老年康复（GR）有益于脆弱老年人住院后的活动和参与恢复，但对于这些急性后期设施的最佳护理组织方式知之甚少。本研究探讨了患者量和服务集中程度与熟练护理设施（SNF）中成功 GR（住院时间短和出院回家）之间的关系。
一项全国多中心回顾性队列研究。
所有在荷兰 SNF 接受 GR 治疗的患者。
护士从患者记录中填写数字登记表。根据 3 个预先确定的诊断组研究患者：全关节置换、创伤性损伤和中风。设施特征通过对设施经理进行结构化电话访谈获得。容量基于 3 个月内的出院人数，并分为低、中、高容量设施。集中程度在组织层面上定义，其中人群由 1 或 2 个诊断组中的 80%或更多组成，前提是至少有 10 张康复床位。
从 88 个设施中，共纳入 2269 名 GR 患者（平均年龄 78.2 岁[标准差 9.7]；68.2%为女性）。SNF 的中位住院时间为 45 天（四分位距 23-81），57%的患者出院回家，9.8%的患者在 GR 期间死亡。在全关节置换患者中（n=501），集中程度与康复成功相关（优势比 5.7；95%置信区间 1.3-24.3；P=0.020，调整年龄和性别后）；但在创伤性损伤或中风患者中未发现这种关系。在任何 3 个诊断组中，容量均与康复成功无关。
本研究可能表明，SNF 中的集中程度（专业化的代表）有利于全关节置换患者的成功 GR。在创伤性损伤或中风组或容量方面，没有发现这种关系。GR 中对功能结果的关系需要进一步研究。
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