养老院或住院康复后功能恢复的患者报告结局。
Patient-Reported Outcomes in Functioning Following Nursing Home or Inpatient Rehabilitation.
机构信息
Department of Psychiatry, University of Rochester Medical Center (URMC), Rochester, NY.
Division of Geriatrics, Department of Medicine, URMC, Rochester, NY.
出版信息
J Am Med Dir Assoc. 2018 Oct;19(10):864-870. doi: 10.1016/j.jamda.2018.06.014. Epub 2018 Jul 25.
OBJECTIVES
Our study examines factors associated with patient-reported outcomes in functioning among Medicare beneficiaries who reported receiving rehabilitation services in a nursing home or inpatient (ie, hospital or rehabilitation facility) setting in the prior year.
DESIGN
Data are from the 2015 and 2016 rounds of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older.
SETTING AND PARTICIPANTS
A total of 479 participants in the 2016 sample who reported receiving rehabilitation services in a nursing home or inpatient setting in the past year.
MEASURES
Bivariate and logistic regression analyses examined the association of demographic, socioeconomic status, and health variables (from the 2015 interview) and rehabilitation characteristics (from the 2016 interview) with patient-reported improvement in "functioning and ability to do activities" while receiving rehabilitation services in the past year.
RESULTS
Among Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings, 33.4% (weighted percent) reported no improvement in functioning while they were receiving rehabilitation. In a regression analysis that accounted for demographics, those with a high school education or less (compared with those with a college degree), instrumental activities of daily living impairments, certain primary conditions for rehabilitation, less than 1-month total duration of rehabilitation services, and no outpatient rehabilitation services had greater odds of reporting no improvement.
CONCLUSIONS/IMPLICATIONS: Our weighted sample represents approximately 2.3 million Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings. In this sample, 1 in 3 reported no improvement in functioning, with differences in patient-reported outcomes across socioeconomic status, health status, and rehabilitation characteristics domains. Consideration of characteristics across these domains may be clinically pertinent, but investigation as to why these differences are present and whether services can be optimized to further improve patient-reported outcomes is warranted.
目的
本研究考察了在过去一年中在疗养院或住院（即医院或康复机构）环境中接受康复服务的医疗保险受益人的报告的功能方面的患者报告结果相关因素。
设计
数据来自国家健康与老龄化趋势研究（NHATS）的 2015 年和 2016 年两轮，这是一项对 65 岁及以上医疗保险受益人的全国代表性样本进行的纵向研究。
地点和参与者
2016 年样本中共有 479 名参与者报告在过去一年中在疗养院或住院环境中接受康复服务。
措施
使用二变量和逻辑回归分析，研究了人口统计学，社会经济地位和健康变量（来自 2015 年的访谈）以及康复特征（来自 2016 年的访谈）与过去一年中接受康复服务时报告的“功能和活动能力”改善之间的关联。
结果
在接受疗养院或住院环境中康复服务的医疗保险受益人中，有 33.4％（加权百分比）报告在接受康复治疗时功能没有改善。在考虑了人口统计学因素的回归分析中，与具有大学学历的人相比，具有高中学历或以下学历（与具有大学学历的人相比），日常生活活动能力受损，某些康复主要条件，康复服务总持续时间少于 1 个月，且无门诊康复服务的人报告没有改善的可能性更大。
结论/意义：我们的加权样本代表了大约 230 万在疗养院或住院环境中接受康复服务的医疗保险受益人。在该样本中，有 1/3 的人报告功能没有改善，患者报告的结果在社会经济地位，健康状况和康复特征领域存在差异。考虑这些领域的特征可能具有临床意义，但是需要进一步调查为什么会存在这些差异，以及是否可以优化服务以进一步改善患者报告的结果。
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