美国缺血性脑卒中患者使用医院康复服务和再次住院情况。
Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States.
机构信息
College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona.
Department of Health Services, Policy & Practices, School of Public Health, Brown University, Providence, Rhode Island; Providence Veterans Affairs Medical Center, Providence, Rhode Island.
出版信息
Arch Phys Med Rehabil. 2019 Jul;100(7):1218-1225. doi: 10.1016/j.apmr.2018.12.028. Epub 2019 Jan 24.
OBJECTIVE
To examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke.
DESIGN
Secondary analysis of inpatient Medicare claims data using Standard Analytical Files.
SETTING
Acute hospitals across the United States.
PARTICIPANTS
From nationwide data, Medicare fee-for-service beneficiaries (N=88,826) aged 66 years or older hospitalized for ischemic stroke between January to November 2010.
INTERVENTIONS
Hospital-based rehabilitation services were quantified using Medicare inpatient claims revenue center codes for evaluation (occupational therapy [OT] and physical therapy [PT]), as well as the number of therapy units delivered. Therapy minutes for both OT and PT services were categorized into none, low, medium, and high.
MAIN OUTCOME MEASURES
All-cause 30-day hospital readmission. A generalized linear mixed model was used to examine the effect of hospital-based rehabilitation services on 30-day hospital readmission, after adjusting for patient and hospital characteristics.
RESULTS
In fully adjusted models, compared to patients who received no PT, we observed a monotonic inverse relationship between the amount of PT and hospital readmission. For low PT (30 minutes), the odds ratio (OR) was 0.90 (95% confidence interval [CI], 0.83-0.96). For medium PT (>30 to ≤75 minutes), the OR was 0.89 (95% CI, 0.82-0.95). For high PT (>75 minutes), the OR was 0.86 (95% CI, 0.80-0.93).
CONCLUSION
Hospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.
目的
研究医院康复服务的使用与缺血性脑卒中患者全因 30 天再入院之间的关系。
设计
利用标准分析文件对医疗保险住院索赔数据进行二次分析。
地点
美国各地的急性医院。
参与者
从全国范围内的数据中，选择 Medicare 收费服务受益人（N=88826），年龄在 66 岁或以上，于 2010 年 1 月至 11 月期间因缺血性脑卒中住院。
干预措施
使用 Medicare 住院索赔收入中心代码对医院康复服务进行量化，包括评估的职业治疗（OT）和物理治疗（PT）以及治疗单元数量。OT 和 PT 服务的治疗分钟数分为无、低、中、高。
主要观察指标
全因 30 天再入院。使用广义线性混合模型，在调整患者和医院特征后，研究医院康复服务对 30 天再入院的影响。
结果
在完全调整的模型中，与未接受 PT 的患者相比，我们观察到接受的 PT 量与医院再入院之间存在单调反比关系。对于低 PT（30 分钟），比值比（OR）为 0.90（95%置信区间[CI]，0.83-0.96）。对于中 PT（>30 至≤75 分钟），OR 为 0.89（95%CI，0.82-0.95）。对于高 PT（>75 分钟），OR 为 0.86（95%CI，0.80-0.93）。
结论
在缺血性脑卒中患者中，医院提供的 PT 服务与降低 30 天再入院风险相关。
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