腹部手术后选择康复治疗环境：我们做对了吗？
Selecting post-acute care settings after abdominal surgery: Are we getting it right?
机构信息
Department of Surgery, University of Alabama at Birmingham, 1600 7th Ave South, Lowder Building Suite 500, Birmingham, AL 35233, United States; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, United States.
University of Wisconsin, 600 Highland Ave, Madison, WI 53792, United States.
出版信息
Am J Surg. 2018 Aug;216(2):260-266. doi: 10.1016/j.amjsurg.2017.08.043. Epub 2017 Sep 20.
BACKGROUND
We investigated whether variation in post-acute care (PAC) services could be explained by surgeons discharging clinically similar patients to different PAC destinations, including home health (HH), skilled nursing facilities (SNF), and inpatient rehabilitation (IR).
METHODS
We studied patients having colectomy, pancreatectomy or hepatectomy in the 2008-2011 Nationwide Inpatient Sample. We used propensity matching to determine: 1. Proportion of patients discharged to SNF/IR who could be matched to clinically similar patients discharged with HH. 2. Potential cost savings from greater use of HH.
RESULTS
30,843 patients were discharged with HH and 23,172 to SNF or IR. 14,163 (61%) SNF/IR patients could be matched to similar patients discharged with HH. Potential cost savings from increasing use of HH as an alternative to SNF/IR ranged from $2.5-$438 million annually.
CONCLUSIONS
There is considerable potential for reducing variation in PAC use and costs by better understanding how surgeons make decisions about PAC placement.
背景
我们研究了术后康复护理（PAC）服务的差异是否可以用外科医生将临床相似的患者送往不同的 PAC 目的地来解释，包括家庭健康（HH）、熟练护理设施（SNF）和住院康复（IR）。
方法
我们研究了 2008 年至 2011 年全国住院患者样本中接受结肠切除术、胰腺切除术或肝切除术的患者。我们使用倾向匹配来确定：1. 可以与 HH 出院的临床相似患者相匹配的 SNF/IR 出院患者的比例。2. 更多使用 HH 带来的潜在成本节约。
结果
30843 名患者出院后接受 HH 治疗，23172 名患者出院后接受 SNF 或 IR 治疗。14163（61%）名 SNF/IR 患者可以与 HH 出院的类似患者相匹配。每年通过将 HH 更多地用作 SNF/IR 的替代方案，潜在的成本节约范围为 2500 万至 4.38 亿美元。
结论
通过更好地了解外科医生如何做出 PAC 安置决策，可以大大降低 PAC 使用和成本的差异。
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