Dieter William B, Collins John P, Guccione Andrew A
Fox Rehabilitation, Cherry Hill, NJ, USA.
Department of Rehabilitation Science, George Mason University, Fairfax, VA, USA.
BMC Geriatr. 2019 May 27;19(1):146. doi: 10.1186/s12877-019-1147-6.
Understanding the provision of health services to community-dwelling older adults is of great importance due to regulatory changes within post-acute care. The aim of this study was to illustrate pathways by which older adults, within an innovative post-acute care delivery model, move to either independence or re-admission back into higher levels of care to maximize the value of rehabilitation delivery.
Clinical data specific to an episode of care (n = 30,001) provided to Medicare beneficiaries treated via a rehabilitation house-calls model of care in their homes and senior living communites were separated into training and test sets. Classification trees were fit on the training set's administrative and clinical variables. Descriptive statistics were calculated for the overall sample, patient characteristics, clinical characteristics, and clinical outcomes.
Subjects were 83.3 years on average, 69.4% were female, and 62.2% were seen in their own homes while 37.8% were in senior living. The key variables predictive of progressing to independence were total number of visits, the presence of the Patient Specific Functional Scale (PSFS), PSFS score at discharge and change in PSFS. Prediction accuracy of the classification tree on the test set was 82.4%.
Older adults progress to a higher degree of independence, instead of higher levels of care, via several distinct pathways within a rehabilitation house-calls model of care. A mix of service utilization and outcome variables are key predictors of each pathway and may be used to maximize the value of service delivery. Further examination of the predictors of outcome using administrative datasets drawn from different sub-sets of older adults across the post-acute care continuum is warranted.
由于急性后期护理的监管变化，了解为社区居住的老年人提供卫生服务非常重要。本研究的目的是阐明在创新的急性后期护理提供模式下，老年人走向独立或重新入住更高水平护理机构的途径，以最大限度地提高康复服务的价值。
将通过康复上门服务模式在其家中和老年生活社区接受治疗的医疗保险受益人的特定护理事件（n = 30,001）的临床数据分为训练集和测试集。根据训练集的管理和临床变量构建分类树。计算总体样本、患者特征、临床特征和临床结果的描述性统计数据。
受试者平均年龄为83.3岁，69.4%为女性，62.2%在自己家中接受治疗，37.8%在老年生活社区。预测走向独立的关键变量是就诊总次数、患者特定功能量表（PSFS）的存在、出院时的PSFS评分以及PSFS的变化。测试集上分类树的预测准确率为82.4%。
在康复上门服务模式下，老年人通过几种不同的途径实现更高程度的独立，而非更高水平的护理。服务利用和结果变量的组合是每条途径的关键预测因素，可用于最大限度地提高服务提供的价值。有必要使用来自急性后期护理连续体中不同老年人群体子集的行政数据集进一步检查结果的预测因素。
