在熟练护理机构中创伤性脑损伤患者的人群：十年的变化。
Population of Patients With Traumatic Brain Injury in Skilled Nursing Facilities: A Decade of Change.
机构信息
Department of Surgery (Drs Lueckel, Stephen, Benoit, Kheirbek, and Cioffi), Rhode Island Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island; Department of Medicine, Division of Gerontology and Geriatric Medicine at University of Washington, Seattle (Dr Teno); and School of Public Health at Brown University, Providence Veterans Affairs Medical Center, Rhode Island (Dr Thomas).
出版信息
J Head Trauma Rehabil. 2019 Jan/Feb;34(1):E39-E45. doi: 10.1097/HTR.0000000000000393.
OBJECTIVE
To describe the natural history of patients with traumatic brain injury (TBI) admitted to skilled nursing facilities (SNFs) following hospitalizations.
SETTING
Between 2005 and 2014.
PARTICIPANTS
Adults who had incident admissions to skilled nursing facilities (SNFs) with a diagnosis of TBI.
DESIGN
Retrospective review of the Minimum Data Set.
MAIN MEASURES
Main variables were cognitive and physical function, length of stay, presence of feeding tube, terminal condition, and dementia.
RESULTS
Incident admissions to SNFs increased annually from 17 247 patients to 20 787 from 2005 to 2014. The percentage of patients with activities of daily living score 23 or more decreased from 25% to 14% (P < .05). The overall percentage of patients with severe cognitive impairment decreased from 18% to 10% (P < .05). More patients had a diagnosis of dementia in 2014 compared with previous years (P < .05), and the presence of a terminal condition increased from 1% to 1.5% over the 10-year period (P < .05). The percentage of patients who stayed fewer than 30 days was noted to increase steadily over the 10 years, starting with 48% in 2005 and ending with 53% in 2013 (P < .05).
CONCLUSION
Understanding past trends in TBI admissions to SNFs is necessary to guide appropriate discharge and predict future demand, as well as inform SNF policy and practice necessary to care for this subgroup of patients.
目的
描述因创伤性脑损伤（TBI）住院后入住熟练护理机构（SNF）的患者的自然史。
地点
2005 年至 2014 年之间。
参与者
有 SNF 入院的成年人，诊断为 TBI。
设计
对最小数据集的回顾性审查。
主要措施
主要变量是认知和身体功能、住院时间、是否存在喂养管、终末状态和痴呆。
结果
2005 年至 2014 年，SNF 的入院人数从 17247 人增加到 20787 人，每年增加。日常生活活动评分 23 分或以上的患者比例从 25%下降到 14%（P<0.05）。总体上严重认知障碍患者的比例从 18%下降到 10%（P<0.05）。与前几年相比，2014 年有更多的患者被诊断为痴呆（P<0.05），终末状态的存在从 1%增加到 1.5%在这 10 年期间（P<0.05）。在这 10 年中，住院少于 30 天的患者比例稳步上升，2005 年为 48%，2013 年为 53%（P<0.05）。
结论
了解过去 TBI 入住 SNF 的趋势对于指导适当的出院和预测未来的需求，以及告知 SNF 政策和实践以照顾这一亚组患者是必要的。
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