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.
Arch Phys Med Rehabil. 2019 Jul;100(7):1218-1225. doi: 10.1016/j.apmr.2018.12.028. Epub 2019 Jan 24.
To examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke.
Secondary analysis of inpatient Medicare claims data using Standard Analytical Files.
Acute hospitals across the United States.
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.
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.
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.
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).
Hospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.
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。
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。
美国各地的急性医院。
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。
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。
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。
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）。
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。
