Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas; Division of Physical Therapy, Medical University of South Carolina, Charleston, South Carolina.
Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
J Am Med Dir Assoc. 2018 Apr;19(4):348-354.e4. doi: 10.1016/j.jamda.2017.12.003. Epub 2018 Jan 19.
The objectives of this study were to determine the association between patients' functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable hospital readmissions, and to examine common reasons for potentially preventable readmissions.
Retrospective cohort study.
SNFs and acute care hospitals submitting claims to Medicare.
National cohort of Medicare fee-for-service beneficiaries discharged from SNF care between July 15, 2013, and July 15, 2014 (n = 693,808). Average age was 81.4 (SD 8.1) years, 67.1% were women, and 86.3% were non-Hispanic white.
Functional items from the Minimum Data Set 3.0 were categorized into self-care, mobility, and cognition domains. We used specifications for the SNF potentially preventable 30-day postdischarge readmission quality metric to identify potentially preventable readmissions.
The overall observed rate of 30-day potentially preventable readmissions following SNF discharge was 5.7% (n = 39,318). All 3 functional domains were independently associated with potentially preventable readmissions in the multivariable models. Odds ratios for the most dependent category versus the least dependent category from multilevel models adjusted for patients' sociodemographic and clinical characteristics were as follows: mobility, 1.54 (95% confidence interval [CI] 1.49-1.59); self-care, 1.50 (95% CI 1.44-1.55); and cognition, 1.12 (95% CI 1.04-1.20). The 5 most common conditions were congestive heart failure (n = 7654, 19.5%), septicemia (n = 7412, 18.9%), urinary tract infection/kidney infection (n = 4297, 10.9%), bacterial pneumonia (n = 3663, 9.3%), and renal failure (n = 3587, 9.1%). Across all 3 functional domains, septicemia was the most common condition among the most dependent patients and congestive heart failure among the least dependent.
Patients with functional limitations at SNF discharge are at increased risk of hospital readmissions considered potentially preventable. Future research is needed to determine whether improving functional status reduces risk of potentially preventable readmissions among this vulnerable population.
本研究旨在确定在熟练护理机构（SNF）出院时患者的功能状态与 30 天内潜在可预防的住院再入院之间的关系，并探讨潜在可预防再入院的常见原因。
回顾性队列研究。
向医疗保险支付费用的 SNF 和急性护理医院提交索赔。
2013 年 7 月 15 日至 2014 年 7 月 15 日期间从 SNF 护理出院的全国性医疗保险费用服务受益人的队列（n=693808）。平均年龄为 81.4（SD 8.1）岁，67.1%为女性，86.3%为非西班牙裔白人。
最小数据集中的功能项目 3.0 分为自我护理、移动性和认知域。我们使用 SNF 潜在可预防 30 天出院后再入院质量指标的规范来确定潜在可预防的再入院。
SNF 出院后 30 天内潜在可预防再入院的总体观察率为 5.7%（n=39318）。所有 3 个功能域在多变量模型中均与潜在可预防的再入院独立相关。从调整患者社会人口统计学和临床特征的多层次模型中最依赖类别与最不依赖类别的比值比如下：移动性，1.54（95%置信区间[CI] 1.49-1.59）；自我护理，1.50（95% CI 1.44-1.55）；认知，1.12（95% CI 1.04-1.20）。最常见的 5 种疾病是充血性心力衰竭（n=7654，19.5%）、败血症（n=7412，18.9%）、尿路感染/肾脏感染（n=4297，10.9%）、细菌性肺炎（n=3663，9.3%）和肾衰竭（n=3587，9.1%）。在所有 3 个功能域中，败血症是最依赖患者中最常见的疾病，充血性心力衰竭是最不依赖患者中最常见的疾病。
在 SNF 出院时功能受限的患者有更高的医院再入院风险，被认为是潜在可预防的。需要进一步研究以确定改善功能状态是否会降低这一脆弱人群潜在可预防再入院的风险。
