Chen Cynthia, Naidoo Nasheen, Er Benjamin, Cheong Angela, Fong Ngan Phoon, Tay Choo Yian, Chan Kin Ming, Tan Boon Yeow, Menon Edward, Ee Chye Hua, Lee Kok Keng, Ng Yee Sien, Teo Yik Ying, Koh Gerald C H
Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
Planning Division, Agency for Integrated Care, Singapore, Singapore.
PLoS One. 2013 Dec 23;8(12):e82697. doi: 10.1371/journal.pone.0082697. eCollection 2013.
To (1) identify social and rehabilitation predictors of nursing home placement, (2) investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore.
National data were retrospectively extracted from medical records of community hospital.
There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3%) patients were discharged home and 924 (9.7%) patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37), other community hospital (n = 31), death in community hospital (n = 12), acute hospital (n = 1,182) and discharge against doctor's advice (n = 24) were excluded.
Nursing home placement.
Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years), had lower mean Bathel Index scores (40 vs. 48), a longer median length of stay (40 vs. 33 days) and a longer time to rehabilitation (19 vs. 15 days), had a higher proportion without a caregiver (28 vs. 7%), being single (21 vs. 7%) and had dementia (23 vs. 10%). Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001) and 65% (p = 0.043) respectively compared to stroke patients.
In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such as fractures, lower limb amputation and falls in comparison to strokes.
（1）确定疗养院安置的社会和康复预测因素；（2）调查1996年至2005年新加坡因疾病入住住院康复机构的患者康复效果和效率与疗养院安置之间的关联。
从社区医院的病历中回顾性提取全国数据。
四家社区医院有12,506例首次康复入院病例。其中，8,594例（90.3%）患者出院回家，924例（9.7%）患者出院后入住疗养院。其他出院去向，如庇护所（n = 37）、其他社区医院（n = 31）、在社区医院死亡（n = 12）、急性医院（n = 1,182）和违反医嘱出院（n = 24）被排除。
疗养院安置。
与出院回家的患者相比，出院后入住疗养院的患者康复效果中位数低33%，康复效率中位数低29%。出院后入住疗养院的患者年龄明显更大（平均年龄：77岁对73岁），平均巴氏指数得分更低（40对48），中位住院时间更长（40天对33天），康复时间更长（19天对15天），无照料者的比例更高（28%对7%），单身比例更高（21%对7%），患痴呆症的比例更高（23%对10%）。与中风患者相比，因下肢截肢或跌倒入院的患者出院后入住疗养院的几率分别增加了175%（p<0.001）和65%（p = 0.043）。
在我们的研究中，发现华裔、男性、单身或丧偶或分居/离婚、在医院高补贴病房的患者、患有痴呆症、无照料者、入院时功能评分较低、出院时康复效果或效率较低以及诸如骨折、下肢截肢和跌倒等主要诊断组的患者，与中风患者相比，入住疗养院的几率增加。
