Keeney Tamra, Jette Diane U, Cabral Howard, Jette Alan M
School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts.
Department of Physical Therapy, MGH Institute of Health Professions, Boston, Massachusetts.
J Geriatr Phys Ther. 2021;44(2):101-107. doi: 10.1519/JPT.0000000000000243.
Although there have been decreases noted in 30-day readmission rates for persons with heart failure since enactment of the Hospital Readmissions Reduction Program, costs related to heart failure readmissions remain high. Consequently, there is a need to better identify persons with heart failure who are at risk for 30-day hospital readmission. Therefore, this study aimed to compare the ability of measures of function and frailty to predict 30-day hospital readmissions for adults 65 years and older with heart failure.
Secondary data analysis using the 2011 National Health and Aging Trends Study analysis merged with Medicare claims data. Logistic regression modeling was used to compare the ability of function (Short Physical Performance Battery) and frailty (Fried's Physical Frailty Phenotype) to predict 30-day readmission. Receiver operating characteristic curves were constructed to examine the ability of function and frailty to identify those who were readmitted.
Frailty and function demonstrated comparable ability to predict 30-day readmissions (R2 = 0.087 and R2 = 0.087, respectively). Neither measure identified persons at risk for readmission (AUCSPPB = 0.608; AUCPFP = 0.587).
Functional assessment demonstrated comparable ability to predict 30-day readmissions in persons with heart failure compared with frailty. However, neither measure was able to identify persons at high risk for readmission. Although frailty status is emphasized in research for older adults with heart failure, functional status is an important patient-level factor associated with readmission.
尽管自《医院再入院率降低计划》颁布以来，心力衰竭患者的30天再入院率有所下降，但与心力衰竭再入院相关的成本仍然很高。因此，有必要更好地识别有30天医院再入院风险的心力衰竭患者。因此，本研究旨在比较功能和衰弱测量指标对65岁及以上心力衰竭成年患者30天医院再入院的预测能力。
使用2011年国家健康与老龄化趋势研究分析与医疗保险理赔数据进行二次数据分析。采用逻辑回归模型比较功能（简短体能状况量表）和衰弱（弗里德身体衰弱表型）对30天再入院的预测能力。构建受试者工作特征曲线以检验功能和衰弱识别再入院患者的能力。
衰弱和功能在预测30天再入院方面表现出相当的能力（R2分别为0.087和0.087）。两种测量方法均未识别出有再入院风险的患者（简短体能状况量表曲线下面积 = 0.608；弗里德身体衰弱表型曲线下面积 = 0.587）。
与衰弱相比，功能评估在预测心力衰竭患者30天再入院方面表现出相当的能力。然而，两种测量方法均无法识别出有高再入院风险的患者。尽管在老年心力衰竭患者的研究中强调了衰弱状态，但功能状态是与再入院相关的重要患者层面因素。
