Arling Greg, Ofner Susan, Reeves Mathew J, Myers Laura J, Williams Linda S, Daggy Joanne K, Phipps Michael S, Chumbler Neale, Bravata Dawn M
From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.).
Circ Cardiovasc Qual Outcomes. 2015 Oct;8(6 Suppl 3):S131-40. doi: 10.1161/CIRCOUTCOMES.115.002068.
Recovery after a stroke varies greatly between individuals and is reflected by wide variation in the use of institutional and home care services. This study sought to classify veterans according to their care trajectories in the 12 months after hospitalization for ischemic stroke.
The sample consisted of 3811 veterans hospitalized for ischemic stroke in Veterans Health Administration facilities in 2007. Three outcomes--nursing home care, home care, and mortality--were modeled jointly >12 months using latent class growth analysis. Data on Veterans' care use and cost came from the Veterans Administration and Medicare. Covariates included stroke severity (National Institutes of Health Stroke Scale), functional status (functional independence measure score), age, marital status, chronic conditions, and prestroke ambulation. Five care trajectories were identified: 49% of Veterans had Rapid Recovery with little or no use of care; 15% had a Steady Recovery with initially high nursing home or home care that tapered off; 9% had Long-Term Home Care; 13% had Long-Term Nursing Home Care; and 14% had an Unstable trajectory with multiple transitions between long-term and acute care settings. Care use was greatest for individuals with more severe strokes, lower functioning at hospital discharge, and older age. Average annual costs were highest for individuals with the Long-Term Nursing Home trajectory ($63,082), closely followed by individuals with the Unstable trajectory ($58,720). Individual with the Rapid Recovery trajectory had the lowest costs ($9271).
Care trajectories after stroke were associated with stroke severity and functional dependency and they had a dramatic impact on subsequent costs.
中风后的恢复情况因人而异，这体现在机构护理和家庭护理服务使用情况的广泛差异上。本研究旨在根据缺血性中风住院后12个月内的护理轨迹对退伍军人进行分类。
样本包括2007年在退伍军人健康管理局设施中因缺血性中风住院的3811名退伍军人。使用潜在类别增长分析对三个结果——养老院护理、家庭护理和死亡率——在12个月以上进行联合建模。退伍军人护理使用和费用的数据来自退伍军人管理局和医疗保险。协变量包括中风严重程度（国立卫生研究院中风量表）、功能状态（功能独立性测量评分）、年龄、婚姻状况、慢性病和中风前行走能力。确定了五种护理轨迹：49%的退伍军人恢复迅速，很少或不使用护理；15%的人稳步恢复，最初使用大量养老院或家庭护理，随后逐渐减少；9%的人长期接受家庭护理；13%的人长期接受养老院护理；14%的人轨迹不稳定，在长期和急性护理环境之间多次转换。中风更严重、出院时功能较低和年龄较大的个体护理使用最多。长期养老院轨迹的个体平均年度费用最高（63,082美元），紧随其后的是轨迹不稳定的个体（58,720美元）。恢复迅速轨迹的个体费用最低（9271美元）。
中风后的护理轨迹与中风严重程度和功能依赖性相关，对后续费用有显著影响。
