Jia Huanguang, Pei Qinglin, Sullivan Charles T, Cowper Ripley Diane C, Wu Samuel S, Vogel W Bruce, Wang Xinping, Bidelspach Douglas E, Hale-Gallardo Jennifer L, Bates Barbara E
Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Washington, DC.
J Multidiscip Healthc. 2017 Mar 1;10:75-85. doi: 10.2147/JMDH.S123905. eCollection 2017.
Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors' functional recovery and daily living activities. The US Department of Veterans Affairs (VA) places veterans needing post-acute institutional care in private community nursing homes (CNHs). These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans' health services as well as the geographic variation of the service utilization.
The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care.
This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents) for the study CNHs was linked with veterans' inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation therapy and restorative nursing care utilization by veterans during their CNH stays.
The study comprised 6,206 veterans at 2,511 CNHs. Rates for utilization of rehabilitation therapy and restorative nursing care were 75.7% and 30.1%, respectively. Veterans in North Atlantic and Southeast CNHs were significantly (<0.001) more likely to receive rehabilitation therapies than veterans from other regions. However, veterans in Southeast CNHs were significantly (<0.001) less likely to receive restorative nursing care compared with veterans in all other regions, before and after risk adjustment.
The majority of veterans with stroke received rehabilitation therapy, and about one-third had restorative nursing care during their stay at VA-contracted CNHs. Significant regional variations in weekly days for rehabilitation therapy and restorative nursing care utilization were observed even after adjusting for potential risk factors.
有效的急性后期多学科康复治疗可改善中风幸存者的功能恢复及日常生活活动能力。美国退伍军人事务部（VA）将需要急性后期机构护理的退伍军人安置在私立社区疗养院（CNH）。这些安置是依据VA医疗系统的相同规章制度，并通过当地VA设施与CNH之间的每日单独合同进行的。然而，关于这些退伍军人健康服务的利用情况以及服务利用的地理差异的信息有限。
本研究的目的是确定在VA签约的CNH中中风退伍军人的康复治疗和恢复性护理利用情况，并评估康复治疗和恢复性护理利用的风险调整区域差异。
这项回顾性研究纳入了2006年至2009年间居住在VA签约的CNH中的所有被诊断为中风的退伍军人。研究CNH的最小数据集（一种用于CNH居民的健康状况评估工具）与VA医疗系统内退伍军人的住院和门诊数据相关联。CNH被分为VA定义的五个地理区域：北大西洋、东南部、中西部、大陆和太平洋地区。应用两部分模型估计风险调整后的利用概率和平均每周利用天数。两个因变量是退伍军人在CNH住院期间的康复治疗和恢复性护理利用情况。
该研究包括2511个CNH中的6206名退伍军人。康复治疗和恢复性护理的利用率分别为75.7%和30.1%。与其他地区的退伍军人相比，北大西洋和东南部CNH中的退伍军人接受康复治疗的可能性显著更高（<0.001）。然而，在风险调整前后，东南部CNH中的退伍军人接受恢复性护理的可能性与所有其他地区的退伍军人相比显著更低（<0.001）。
大多数中风退伍军人在入住VA签约的CNH期间接受了康复治疗，约三分之一接受了恢复性护理。即使在调整潜在风险因素后，仍观察到康复治疗和恢复性护理利用的每周天数存在显著区域差异。
