中风康复强度与再次入院风险的关联

Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission.

作者信息

Andrews A Williams, Li Dongmei, Freburger Janet K

机构信息

A.W. Andrews, PT, EdD, NCS, Department of Physical Therapy Education, Elon University, Campus Box 2085, Elon, NC 27244 (USA).

D. Li, MS, The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

出版信息

Phys Ther. 2015 Dec;95(12):1660-7. doi: 10.2522/ptj.20140610. Epub 2015 Jun 18.

DOI:10.2522/ptj.20140610

PMID:26089042

Abstract

BACKGROUND

Little is known about the use of rehabilitation in the acute care setting and its impact on hospital readmissions.

OBJECTIVE

The objective of this study was to examine the association between the intensity of rehabilitation services received during the acute care stay for stroke and the risk of 30-day and 90-day hospital readmission.

DESIGN

A retrospective cohort analysis of all acute care hospitals in Arkansas and Florida was conducted.

METHODS

Patients (N=64,065) who were admitted for an incident stroke in 2009 or 2010 were included. Rehabilitation intensity was categorized as none, low, medium-low, medium-high, or high based on the sum and distribution of physical therapy, occupational therapy, and speech therapy charges within each hospital. Cox proportional hazards regression was used to estimate hazard ratios, controlling for demographic characteristics, illness severity, comorbidities, hospital variables, and state.

RESULTS

Relative to participants who received the lowest intensity therapy, those who received higher-intensity therapy had a decreased risk of 30-day readmission. The risk was lowest for the highest-intensity group (hazard ratio=0.86; 95% confidence interval=0.79, 0.93). Individuals who received no therapy were at an increased risk of hospital readmission relative to those who received low-intensity therapy (hazard ratio=1.30; 95% confidence interval=1.22, 1.40). The findings were similar, but with smaller effects, for 90-day readmission. Furthermore, patients who received higher-intensity therapy had more comorbidities and greater illness severity relative to those who received lower-intensity therapy.

LIMITATIONS

The results of the study are limited in scope and generalizability. Also, the study may not have adequately accounted for all potentially important covariates.

CONCLUSIONS

Receipt of and intensity of rehabilitation therapy in the acute care of stroke is associated with a decreased risk of hospital readmission.

摘要

背景

关于急性护理环境中康复治疗的使用及其对医院再入院的影响，人们了解甚少。

目的

本研究的目的是探讨中风急性护理期间接受的康复服务强度与30天和90天医院再入院风险之间的关联。

设计

对阿肯色州和佛罗里达州的所有急性护理医院进行回顾性队列分析。

方法

纳入2009年或2010年因首次中风入院的患者（N = 64,065）。根据每家医院内物理治疗、职业治疗和言语治疗费用的总和及分布情况，将康复强度分为无、低、中低、中高或高。使用Cox比例风险回归来估计风险比，并对人口统计学特征、疾病严重程度、合并症、医院变量和州进行控制。

结果

与接受最低强度治疗的参与者相比，接受更高强度治疗的参与者30天再入院风险降低。最高强度组的风险最低（风险比 = 0.86；95%置信区间 = 0.79, 0.93）。与接受低强度治疗的患者相比，未接受治疗的个体医院再入院风险增加（风险比 = 1.30；95%置信区间 = 1.22, 1.40）。对于90天再入院，结果相似，但影响较小。此外，与接受较低强度治疗的患者相比，接受更高强度治疗的患者合并症更多，疾病严重程度更高。