Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY.
Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY.
J Am Med Dir Assoc. 2019 Oct;20(10):1274-1279.e4. doi: 10.1016/j.jamda.2019.01.136. Epub 2019 Mar 8.
To explore profiles of obese residents who receive post-acute care in nursing homes (NHs) and to assess the relationship between obesity and hospital readmissions and how it is modified by individual comorbidities, age, and type of index hospitalizations.
Retrospective cohort study.
Medicare fee-for-service beneficiaries who were newly admitted to free-standing US NHs after an acute inpatient episode between 2011 and 2014 (N = 2,323,019).
The Minimum Data Set 3.0 were linked with Medicare data. The outcome variable was 30-day hospital readmission from an NH. Residents were categorized into 3 groups based on their body mass index (BMI): nonobese, mildly obese, moderate-to-severely obese. We tested the relationship between obesity and 30-day readmissions by fixed-effects logit models and stratified analyses by the type of index hospitalization and residents' age.
Forty percent of the identified residents were admitted after a surgical episode, and the rest were admitted after a medical episode. The overall relationship between obesity and readmissions suggested that obesity was associated with higher risks of readmission among the oldest old (≥85 years) residents but with lower risks of readmission among the youngest group (65-74 years). After accounting for individual co-covariates, the association between obesity and readmissions among the oldest old residents became weaker; the adjusted odds ratio was 1.061 (P = .049) and 1.004 (P = .829) for moderate-to-severely obese patients with surgical and medical index hospitalizations, respectively. The protective effect of obesity among younger residents reduced after adjusting for covariates.
CONCLUSIONS/RELEVANCE: The relationship between obesity and hospital readmission among post-acute residents could be affected by comorbidities, age, and the type of index hospitalization. Further studies are also warranted to understand how to effectively measure NH quality outcomes, including hospital readmissions, so that policies targeting at quality improvement can successfully achieve their goals without unintended consequences.
探索在养老院（NH）接受康复护理的肥胖居民的特征，并评估肥胖与住院再入院之间的关系，以及这种关系如何受到个体合并症、年龄和索引住院类型的影响。
回顾性队列研究。
2011 年至 2014 年期间，在美国 NH 新接受急性住院治疗后出院的医疗保险付费服务受益人（N=2,323,019）。
将最低数据集 3.0 与医疗保险数据相关联。因变量为 NH 30 天内的再住院。根据其体重指数（BMI），居民分为 3 组：非肥胖、轻度肥胖、中度至重度肥胖。我们通过固定效应逻辑回归模型和按索引住院类型和居民年龄分层分析来测试肥胖与 30 天再入院之间的关系。
确定的居民中有 40%是在手术后入住的，其余的是在手术后入住的。肥胖与再入院之间的总体关系表明，肥胖与最年长的（≥85 岁）居民的再入院风险较高有关，但与最年轻的（65-74 岁）居民的再入院风险较低有关。在考虑了个体协变量后，肥胖与最年长居民再入院之间的关联减弱；调整后的优势比分别为 1.061（P=0.049）和 1.004（P=0.829），中度至重度肥胖患者的手术和医疗索引住院分别为 1.061（P=0.049）和 1.004（P=0.829）。调整协变量后，肥胖对年轻居民的保护作用减弱。
结论/相关性：康复居民的肥胖与住院再入院之间的关系可能受到合并症、年龄和索引住院类型的影响。还需要进一步研究，以了解如何有效衡量 NH 质量结果，包括住院再入院，以便针对质量改进的政策能够成功实现其目标，而不会产生意外后果。
