严重精神障碍养老院居民比例高与居民护理质量的关系。
Association between High Proportions of Seriously Mentally Ill Nursing Home Residents and the Quality of Resident Care.
机构信息
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
出版信息
J Am Geriatr Soc. 2019 Nov;67(11):2346-2352. doi: 10.1111/jgs.16080. Epub 2019 Jul 29.
OBJECTIVES
To examine the association between the quality of care delivered to nursing home residents with and without a serious mental illness (SMI) and the proportion of nursing home residents with SMI.
DESIGN
Instrumental variable study. Relative distance to the nearest nursing home with a high proportion of SMI residents was used to account for potential selection of patients between high- and low-SMI facilities. Data were obtained from the 2006-2010 Minimum Data Set assessments linked with Medicare claims and nursing home information from the Online Survey, Certification, and Reporting database.
SETTING
Nursing homes with high (defined as at least 10% of a facility's population having an SMI diagnosis) and low proportions of SMI residents.
PARTICIPANTS
A total of 58 571 Medicare nursing residents with an SMI diagnosis (ie, schizophrenia or bipolar disorder) and 558 699 individuals without an SMI diagnosis who were admitted to the same nursing homes.
MEASUREMENTS
Outcomes were nursing home quality measures: (1) use of physical restraints, (2) any hospitalization in the last 3 months, (3) use of an indwelling catheter, (4) use of a feeding tube, and (5) presence of pressure ulcer(s).
RESULTS
For individuals with SMI, admission to a high-SMI facility was associated with a 3.7 percentage point (95% confidence interval [CI] = 1.4-6.0) increase in the probability of feeding tube use relative to individuals admitted to a low-SMI facility. Among individuals without SMI, admission to a high-SMI facility was associated with a 1.7 percentage point increase in the probability of catheter use (95 CI = .03-3.47), a 3.8 percentage point increase in the probability of being hospitalized (95% CI = 2.16-5.44), and a 2.1 percentage point increase in the probability of having a feeding tube (95% CI = .43-3.74).
CONCLUSION
Admission to nursing homes with high concentrations of residents with SMI is associated with worse outcomes for both residents with and without SMI. J Am Geriatr Soc 67:2346-2352, 2019.
目的
研究为患有严重精神疾病（SMI）和无 SMI 的养老院居民提供的护理质量与 SMI 居民比例之间的关系。
设计
工具变量研究。使用距离最近的高 SMI 居民养老院的相对距离来解释高 SMI 和低 SMI 设施之间的患者选择情况。数据来自 2006-2010 年最低数据集评估，与医疗保险索赔以及在线调查、认证和报告数据库中的养老院信息相关联。
设置
高 SMI（定义为设施中至少 10%的人口患有 SMI 诊断）和低 SMI 居民比例的养老院。
参与者
共有 58571 名患有 SMI 诊断（即精神分裂症或双相情感障碍）的医疗保险养老院居民和 558699 名无 SMI 诊断但入住同一养老院的个人。
测量
结果是养老院质量测量：（1）使用身体约束，（2）过去 3 个月内任何住院治疗，（3）使用留置导尿管，（4）使用喂养管，（5）存在压疮。
结果
对于患有 SMI 的个体，与入住低 SMI 设施的个体相比，入住高 SMI 设施与使用喂养管的可能性增加 3.7 个百分点（95%置信区间 [CI] = 1.4-6.0）。对于没有 SMI 的个体，入住高 SMI 设施与使用导尿管的可能性增加 1.7 个百分点（95%CI =.03-3.47）、住院的可能性增加 3.8 个百分点（95%CI = 2.16-5.44）以及使用喂养管的可能性增加 2.1 个百分点（95%CI =.43-3.74）。
结论
入住高 SMI 居民集中的养老院与患有和不患有 SMI 的居民的预后都较差有关。美国老年学会杂志 67：2346-2352，2019 年。
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