美国缺血性脑卒中患者住院康复服务的差异。
Variation in Hospital-Based Rehabilitation Services Among Patients With Ischemic Stroke in the United States.
机构信息
College of Health and Human Services, Northern Arizona University, 208 E. Pine Knoll Dr, Flagstaff, AZ 86011 (USA); and Department of Health Services, Policy, and Practices, School of Public Health, Brown University, Providence, Rhode Island.
Department of Health Services, Policy, and Practices, School of Public Health, Brown University.
出版信息
Phys Ther. 2019 May 1;99(5):494-506. doi: 10.1093/ptj/pzz014.
BACKGROUND
Little is known about variation in use of rehabilitation services provided in acute care hospitals for people who have had a stroke.
OBJECTIVE
The objective was to examine patient and hospital sources of variation in acute care rehabilitation services provided for stroke.
DESIGN
This was a retrospective, cohort design.
METHODS
The sample consisted of Medicare fee-for-service beneficiaries with ischemic stroke admitted to acute care hospitals in 2010. Medicare claims data were linked to the Provider of Services file to gather information on hospital characteristics and the American Community Survey for sociodemographic data. Chi-square tests compared patient and hospital characteristics stratified by any rehabilitation use. We used multilevel, multivariable random effect models to identify patient and hospital characteristics associated with the likelihood of receiving any rehabilitation and with the amount of therapy received in minutes.
RESULTS
Among 104,295 patients, 85.2% received rehabilitation (61.5% both physical therapy and occupational therapy; 22.0% physical therapy only; and 1.7% occupational therapy only). Patients received 123 therapy minutes on average (median [SD] = 90.0 [99.2] minutes) during an average length of stay of 4.8 [3.5] days. In multivariable analyses, male sex, dual enrollment in Medicare and Medicaid, prior hospitalization, ICU stay, and feeding tube were associated with lower odds of receiving any rehabilitation services. These same variables were generally associated with fewer minutes of therapy. Patients treated by tissue plasminogen activator, in limited-teaching and nonteaching hospitals, and in hospitals with inpatient rehabilitation units, were more likely to receive more therapy minutes.
LIMITATION
The findings are limited to patients with ischemic stroke.
CONCLUSION
Only 61% of patients with ischemic stroke received both physical therapy and occupational therapy services in the acute setting. We identified considerable variation in the use of rehabilitation services in the acute care setting following a stroke.
背景
对于在急性护理医院接受过中风治疗的患者，康复服务的使用情况存在很大差异，但目前对此知之甚少。
目的
本研究旨在探讨患者和医院因素对中风患者急性护理康复服务的使用差异。
设计
这是一项回顾性队列设计。
方法
该研究样本为 2010 年因缺血性中风入住急性护理医院的 Medicare 按服务收费计划的受益人群。将 Medicare 索赔数据与服务提供方文件相链接，以获取有关医院特征和美国社区调查社会人口学数据的信息。通过卡方检验比较了按任何康复治疗使用情况分层的患者和医院特征。使用多水平、多变量随机效应模型，确定与接受任何康复治疗的可能性以及治疗分钟数相关的患者和医院特征。
结果
在 104295 名患者中，85.2%接受了康复治疗（61.5%同时接受物理治疗和职业治疗；22.0%仅接受物理治疗；1.7%仅接受职业治疗）。患者的平均治疗时间为 123 分钟（中位数[SD] = 90.0 [99.2]分钟），平均住院时间为 4.8 [3.5]天。在多变量分析中，男性、同时参加医疗保险和医疗补助、既往住院、入住 ICU 和置管与接受任何康复服务的可能性较低相关。这些变量通常与治疗时间较短相关。接受组织型纤溶酶原激活剂治疗、在有限教学和非教学医院以及有住院康复病房的医院的患者，更有可能接受更多的治疗分钟数。
局限性
研究结果仅限于缺血性中风患者。
结论
仅有 61%的缺血性中风患者在急性治疗环境中同时接受物理治疗和职业治疗服务。我们发现，在中风后急性护理环境中，康复服务的使用存在相当大的差异。
Zotero 插件