Tanuseputro Peter, Chalifoux Mathieu, Bennett Carol, Gruneir Andrea, Bronskill Susan E, Walker Peter, Manuel Douglas
Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
J Am Med Dir Assoc. 2015 Oct 1;16(10):874-83. doi: 10.1016/j.jamda.2015.06.004.
To establish if proprietary status (ie, for-profit or not-for-profit) is associated with mortality and hospitalizations among publicly funded long-term care (nursing) homes.
We conducted a retrospective cohort study of new admissions in 640 publicly funded long-term care facilities in Ontario, Canada (384 for-profit, 256 not-for-profit). A population-based cohort of 53,739 incident admissions into long-term care facilities between January 1, 2010, and March 1, 2012, was observed. We measured adjusted rates of hospital admissions and mortality, per 1000 person-years (PY) of follow-up, among for-profit and not-for-profit facilities at 3, 6, and 12 months postadmission. Rates were measured postadmission and until discharge or death, whichever came first.
One year after admission and before discharge, 11.7% of residents died and 25.7% had at least one hospitalization. After 12 months of follow-up, residents in for-profit facilities had a hospitalization rate of 462 per 1000 PY versus 358 per 1000 PY in not-for-profit facilities. During this period, the crude mortality rate in for-profit facilities was 208 per 1000 PY versus 185 per 1000 PY in not-for-profit facilities. At 3, 6, and 1 year after admission, for-profit facilities had an adjusted hazard ratio of 1.36 (95% confidence interval [CI] 1.28-1.43), 1.33 (95% CI 1.27-1.39), and 1.25 (95% CI 1.21-1.30) for hospitalizations and hazards of 1.20 (95% CI 1.11-1.29), 1.16 (95% CI 1.09-1.24), and 1.10 (95% CI 1.05-1.16) for mortality, respectively.
Publicly funded for-profit facilities have significantly higher rates of both mortality and hospital admissions.
确定所有权性质（即营利性或非营利性）是否与公共资助的长期护理（疗养院）机构中的死亡率和住院率相关。
我们对加拿大安大略省640家公共资助的长期护理机构中的新入院患者进行了一项回顾性队列研究（384家营利性机构，256家非营利性机构）。观察了2010年1月1日至2012年3月1日期间以人群为基础的53739例长期护理机构入院事件队列。我们测量了营利性和非营利性机构入院后3个月、6个月和12个月时每1000人年随访的调整后住院率和死亡率。入院后直至出院或死亡（以先发生者为准）测量率。
入院一年后且出院前，11.7%的居民死亡，25.7%的居民至少有一次住院。随访12个月后，营利性机构居民的住院率为每1000人年462例，而非营利性机构为每1000人年358例。在此期间，营利性机构的粗死亡率为每1000人年208例，而非营利性机构为每1000人年185例。入院后3个月、6个月和1年时，营利性机构住院的调整后风险比分别为1.36（95%置信区间[CI]1.28 - 1.43）、1.33（95%CI 1.27 - 1.39）和1.25（95%CI 1.21 - 1.30），死亡风险分别为1.20（95%CI 1.11 - 1.29）、1.16（95%CI 1.09 - 1.24）和1.10（95%CI 1.05 - 1.16）。
公共资助的营利性机构的死亡率和住院率显著更高。
