Galloway Rebecca V, Karmarkar Amol M, Graham James E, Tan Alai, Raji Mukaila, Granger Carl V, Ottenbacher Kenneth J
R.V. Galloway, PT, PhD, Department of Physical Therapy, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-1144 (USA).
A.M. Karmarkar, PhD, MPH, Division of Rehabilitation Sciences, University of Texas Medical Branch.
Phys Ther. 2016 Feb;96(2):241-51. doi: 10.2522/ptj.20150030. Epub 2015 Dec 4.
Debility accounts for 10% of inpatient rehabilitation cases among Medicare beneficiaries. Debility has the highest 30-day readmission rate among 6 impairment groups most commonly admitted to inpatient rehabilitation.
The purpose of this study was to examine rates, temporal distribution, and factors associated with hospital readmission for patients with debility up to 90 days following discharge from inpatient rehabilitation.
A retrospective cohort study was conducted using records for 45,424 Medicare fee-for-service beneficiaries with debility discharged to community from 1,199 facilities during 2006-2009.
Cox proportional hazard regression models were used to estimate hazard ratios for readmission. Schoenfeld residuals were examined to identify covariate-time interactions. Factor-time interactions were included in the full model for Functional Independence Measure (FIM) discharge motor functional status, comorbidity tier, and chronic pulmonary disease. Most prevalent reasons for readmission were summarized by Medicare severity diagnosis related groups.
Hospital readmission rates for patients with debility were 19% for 30 days and 34% for 90 days. The highest readmission count occurred on day 3 after discharge, and 56% of readmissions occurred within 30 days. A higher FIM discharge motor rating was associated with lower hazard for readmissions prior to 60 days (30-day hazard ratio=0.987; 95% confidence interval=0.986, 0.989). Comorbidities with hazard ratios >1.0 included comorbidity tier and 11 Elixhauser conditions, 3 of which (heart failure, renal failure, and chronic pulmonary disease) were among the most prevalent reasons for readmission.
Analysis of Medicare data permitted only use of variables reported for administrative purposes. Comorbidity data were analyzed only for inpatient diagnoses.
One-third of patients were readmitted to acute hospitals within 90 days following rehabilitation for debility. Protective effect of greater motor function was diminished by 60 days after discharge from inpatient rehabilitation.
在医疗保险受益人的住院康复病例中，身体虚弱者占10%。在最常入住住院康复机构的6个损伤组中，身体虚弱者的30天再入院率最高。
本研究的目的是调查住院康复出院后90天内身体虚弱患者的再入院率、时间分布及相关因素。
采用回顾性队列研究，使用2006 - 2009年期间从1199家机构出院至社区的45424名医疗保险按服务付费受益的身体虚弱者的记录。
采用Cox比例风险回归模型估计再入院的风险比。检查Schoenfeld残差以识别协变量 - 时间交互作用。在功能独立性测量（FIM）出院运动功能状态、合并症层级和慢性肺病的完整模型中纳入因素 - 时间交互作用。再入院的最常见原因按医疗保险严重程度诊断相关组进行总结。
身体虚弱患者的30天医院再入院率为19%，90天为34%。再入院人数最多发生在出院后第3天，56%的再入院发生在30天内。较高的FIM出院运动评分与60天前再入院的较低风险相关（30天风险比 = 0.987；95%置信区间 = 0.986，0.989）。风险比>1.0的合并症包括合并症层级和11种Elixhauser疾病，其中3种（心力衰竭、肾衰竭和慢性肺病）是最常见的再入院原因。
医疗保险数据分析仅允许使用出于管理目的报告的变量。合并症数据仅针对住院诊断进行分析。
三分之一的身体虚弱康复患者在90天内再次入住急性医院。从住院康复出院60天后，更大运动功能的保护作用减弱。
