Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
J Am Med Dir Assoc. 2016 Mar 1;17(3):225-31. doi: 10.1016/j.jamda.2015.10.010. Epub 2015 Nov 24.
To identify distinct sets of disability trajectories in the year before and after a Medicare qualifying skilled nursing facility (Q-SNF) admission, evaluate the associations between the pre-and post-Q-SNF disability trajectories, and determine short-term outcomes (readmission, mortality).
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study including 754 community-dwelling older persons, 70+ years, and initially nondisabled in their basic activities of daily living. The analytic sample included 394 persons, with a first hospitalization followed by a Q-SNF admission between 1998 and 2012.
Disability in the year before and after a Q-SNF admission using 13 basic, instrumental, and mobility activities. Secondary outcomes included 30-day readmission and 12-month mortality.
The mean (SD) age of the sample was 84.9 (5.5) years. We identified 3 disability trajectories in the year before a Q-SNF admission: minimal disability (37.3% of participants), mild disability (44.6%), and moderate disability (18.2%). In the year after a Q-SNF admission, all participants started with moderate to severe disability scores. Three disability trajectories were identified: substantial improvement (26.0% of participants), minimal improvement (36.5%), and no improvement (37.5%). Among participants with minimal disability pre-Q-SNF, 52% demonstrated substantial improvement; the other 48% demonstrated minimal improvement (32%) or no improvement (16%) and remained moderately to severely disabled in the year post-Q-SNF. Among participants with mild disability pre-Q-SNF, 5% showed substantial improvement, whereas 95% showed little to no improvement. Of participants with moderate disability pre-Q-SNF, 15% remained moderately disabled showing little improvement, whereas 85% showed no improvement. Participants who transitioned from minimal disability pre-Q-SNF to no improvement post-Q-SNF had the highest rates of 30-day readmission and 12-month mortality (rate/100 person-days 1.3 [95% CI 0.6-2.8] and 0.3 [95% CI 0.15-0.45], respectively).
Among older persons, distinct disability trajectories were observed in the year before and after a Q-SNF admission. The likelihood of improvement in disability was greatly constrained by the pre-Q-SNF disability trajectory. Most older persons remained moderately to severely disabled in the year following a Q-SNF admission.
确定在 Medicare 合格的熟练护理机构（Q-SNF）入院前后一年中不同的残疾轨迹，并评估入院前后残疾轨迹之间的关联，以及确定短期结果（再入院、死亡率）。
设计、地点和参与者：前瞻性队列研究，纳入 754 名年龄在 70 岁及以上、基本日常生活活动最初无残疾的社区居住者。分析样本包括 394 名患者，他们在 1998 年至 2012 年间首次住院，随后入住 Q-SNF。
使用 13 项基本、工具和移动活动评估 Q-SNF 入院前后一年的残疾情况。次要结局包括 30 天再入院和 12 个月死亡率。
样本的平均（SD）年龄为 84.9（5.5）岁。我们在 Q-SNF 入院前一年确定了 3 种残疾轨迹：轻度残疾（37.3%的参与者）、中度残疾（44.6%）和重度残疾（18.2%）。在 Q-SNF 入院后一年，所有参与者的残疾评分均为中重度。确定了 3 种残疾轨迹：显著改善（26.0%的参与者）、轻度改善（36.5%）和无改善（37.5%）。在 Q-SNF 前轻度残疾的参与者中，52%表现出显著改善；另外 48%表现出轻度改善（32%）或无改善（16%），并且在 Q-SNF 后一年仍处于中重度残疾状态。在 Q-SNF 前轻度残疾的参与者中，5%表现出显著改善，而 95%表现出几乎没有改善。在 Q-SNF 前中度残疾的参与者中，15%仍处于中度残疾，改善程度较小，而 85%没有改善。从 Q-SNF 前轻度残疾转变为 Q-SNF 后无改善的参与者，30 天再入院和 12 个月死亡率最高（发生率/100 人天 1.3[95%CI 0.6-2.8]和 0.3[95%CI 0.15-0.45]）。
在老年人中，在 Q-SNF 入院前后一年中观察到不同的残疾轨迹。在 Q-SNF 入院前的残疾轨迹极大地限制了残疾改善的可能性。大多数老年人在 Q-SNF 入院后一年仍处于中重度残疾状态。
