Gozalo Pedro, Leland Natalie E, Christian Thomas J, Mor Vincent, Teno Joan M
Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.
Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry and Davis School of Gerontology, University of Southern California, Los Angeles, California.
J Am Geriatr Soc. 2015 Oct;63(10):2043-51. doi: 10.1111/jgs.13677. Epub 2015 Oct 1.
To examine the effect of the relationship between volume (number of hip fracture admissions during the 12 months before participant's fracture) and other facility characteristics on outcomes.
Prospective observational study.
U.S. skilled nursing facilities (SNFs) admitting individuals discharged from the hospital after treatment for hip fracture between 2000 and 2007 (N = 15,439).
Community-dwelling fee-for-service Medi-care beneficiaries aged 75 and older admitted to U.S. hospitals for their first hip fracture and discharged to a SNF for postacute care from 2000 to 2007 (N = 512,967).
Successful discharge from SNF to community, defined as returning to the community within 30 days of hospital discharge to the SNF and remaining in the community without being institutionalized for at least 30 days, was examined using Medicare administrative data, propensity score matching, and instrumental variables.
The overall rate of successful discharge to the community was 31%. Of the 15,439 facilities, the facility interquartile range varied from 0% (25th percentile) to 42% (75th percentile). An important determinant of variation in discharge rate was SNF volume of hip fracture admissions. Unadjusted successful discharge from SNF to community was 43.7% in high-volume facilities (>24 admissions/year), versus 18.8% in low-volume facilities (1-6 admissions/year). This facility volume effect persisted after adjusting for participant and facility characteristics associated with outcomes (e.g., adjusted odds ratio = 2.06, 95% confidence interval = 1.91-2.21 for volume of 25 vs 3 admissions per year).
In community-dwelling persons with their first hip fracture, successful return to the community varies substantially according to SNF provider volume and staffing characteristics.
研究数量（参与者骨折前12个月内髋部骨折入院人数）与其他机构特征之间的关系对结局的影响。
前瞻性观察性研究。
2000年至2007年期间接收髋部骨折治疗后出院患者的美国专业护理机构（SNFs）（N = 15439）。
2000年至2007年期间因首次髋部骨折入住美国医院并出院至SNF接受急性后期护理的75岁及以上社区居住的按服务收费的医疗保险受益人（N = 512967）。
使用医疗保险行政数据、倾向得分匹配和工具变量，对从SNF成功出院至社区进行了研究，成功出院定义为在从医院出院至SNF的30天内返回社区，并在社区中停留至少30天且未被机构收容。
成功出院至社区的总体比率为31%。在15439个机构中，机构四分位距范围从0%（第25百分位数）至42%（第75百分位数）不等。出院率差异的一个重要决定因素是SNF髋部骨折入院人数。高入院量机构（每年>24例入院）从SNF至社区的未调整成功出院率为43.7%，而低入院量机构（每年1 - 6例入院）为18.8%。在对与结局相关的参与者和机构特征进行调整后，这种机构入院量效应仍然存在（例如，每年入院25例与3例相比，调整后的优势比 = 2.06，95%置信区间 = 1.91 - 2.21）。
在首次发生髋部骨折的社区居住者中，成功返回社区的情况因SNF提供者的入院量和人员配备特征而有很大差异。
