Schwarzkopf Ran, Ho Jenny, Snir Nimrod, Mukamel Dana D
Department of Orthopaedics Surgery, University of California Irvine, Orange, CA, USA.
Health Policy Research Institute, University of California Irvine, Irvine, CA, USA.
Geriatr Orthop Surg Rehabil. 2015 Sep;6(3):215-9. doi: 10.1177/2151458515593778.
With this growing demand, the length of stay for total hip arthroplasty (THA) procedures has decreased, and as a trade-off, we have seen a higher utilization of extended care facilities (ECFs). Both trends have significant economic implications on the health care system, and predicting the discharge destinations of THA patients would help policy makers plan for future health expenditures. We performed a retrospective data analysis of a large patient database to determine which variables are significant in predicting discharge destinations of THA patients.
We used the California Hospital Discharge data set of the year 2010, collected and provided by the Office of Statewide Health Planning and Development. The data set includes information about patient demographics, insurance type, diagnoses and procedures, and patient disposition. The study cohort included 14 326 patients. Discharge to home was the reference category. Discharge to ECF and discharge to home with home care were the 2 additional alternatives.
In all, 46.9% of patients were discharged home with home health care, followed by 29.6% to ECF, and 23.5% to home without care. Discharge to ECF was more likely for patients with more comorbidities and a higher age. The strongest predictors were Medicaid and black or Asian race. Medicare relative to private payer was a strong predictor of ECF discharge. Male gender was the only factor that lowered the risk of discharge to ECF. The strongest predictor for discharge to home with home care was black race relative to whites. Medicaid lowered the risk of home care, and gender did not matter.
This study serves to provide insight on which patient characteristics influence discharge destination after THA. Race, insurance, and morbidity were highly significant factors on patient discharge destination to a subacute nursing facility.
随着这种需求的不断增长，全髋关节置换术（THA）的住院时间有所缩短，作为一种权衡，我们发现长期护理机构（ECF）的利用率有所提高。这两种趋势对医疗保健系统都有重大的经济影响，预测THA患者的出院去向将有助于政策制定者规划未来的医疗支出。我们对一个大型患者数据库进行了回顾性数据分析，以确定哪些变量对预测THA患者的出院去向具有重要意义。
我们使用了2010年由全州卫生规划与发展办公室收集并提供的加利福尼亚医院出院数据集。该数据集包括患者人口统计学信息、保险类型、诊断和手术以及患者出院情况。研究队列包括14326名患者。出院回家是参照类别。出院到ECF和出院回家并接受家庭护理是另外两种选择。
总体而言，46.9%的患者出院回家并接受家庭医疗护理，其次是29.6%出院到ECF，23.5%出院回家但无需护理。合并症较多和年龄较大的患者更有可能出院到ECF。最强的预测因素是医疗补助以及黑人或亚裔种族。相对于私人支付者，医疗保险是ECF出院的一个强预测因素。男性是唯一降低出院到ECF风险的因素。出院回家并接受家庭护理的最强预测因素是相对于白人的黑人种族。医疗补助降低了接受家庭护理的风险，而性别无关紧要。
本研究旨在深入了解哪些患者特征会影响THA后的出院去向。种族、保险和发病率是影响患者出院到亚急性护理机构的高度重要因素。
