Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-6, Providence, RI, 02912, USA.
Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA.
BMC Geriatr. 2020 Feb 10;20(1):47. doi: 10.1186/s12877-020-1457-8.
Older adults who reside in long-term care facilities (LTCFs) are at particularly high risk for infection, morbidity and mortality from pneumonia and influenza (P&I) compared to individuals of younger age and those living outside institutional settings. The risk factors for P&I hospitalizations that are specific to LTCFs remain poorly understood. Our objective was to evaluate the incidence of P&I hospitalization and associated person- and facility-level factors among post-acute (short-stay) and long-term (long-stay) care residents residing in LTCFs from 2013 to 2015.
In this retrospective cohort study, we used Medicare administrative claims linked to Minimum Data Set and LTCF-level data to identify short-stay (< 100 days, index = admission date) and long-stay (100+ days, index = day 100) residents who were followed from the index date until the first of hospitalization, LTCF discharge, Medicare disenrollment, or death. We measured incidence rates (IRs) for P&I hospitalization per 100,000 person-days, and estimated associations with baseline demographics, geriatric syndromes, clinical characteristics, and medication use using Cox regression models.
We analyzed data from 1,118,054 short-stay and 593,443 long-stay residents. The crude 30-day IRs (95% CI) of hospitalizations with P&I in the principal position were 26.0 (25.4, 26.6) and 34.5 (33.6, 35.4) among short- and long-stay residents, respectively. The variables associated with P&I varied between short and long-stay residents, and common risk factors included: advanced age (85+ years), admission from an acute hospital, select cardiovascular and respiratory conditions, impaired functional status, and receipt of antibiotics or Beers criteria medications. Facility staffing and care quality measures were important risk factors among long-stay residents but not in short-stay residents.
Short-stay residents had lower crude 30- and 90-day incidence rates of P&I hospitalizations than long-stay LTCF residents. Differences in risk factors for P&I between short- and long-stay populations suggest the importance of considering distinct profiles of post-acute and long-term care residents in infection prevention and control strategies in LTCFs. These findings can help clinicians target interventions to subgroups of LTCF residents at highest P&I risk.
与年轻人群体和居住在机构外的人群相比，长期护理机构（LTCF）中的老年人感染肺炎和流感（P&I）后，发病率、发病率和死亡率尤其高。特定于 LTCF 的 P&I 住院的危险因素仍知之甚少。我们的目标是评估 2013 年至 2015 年期间居住在 LTCF 中的急性后（短期）和长期（长期）护理居民的 P&I 住院率以及与个人和设施相关的因素。
在这项回顾性队列研究中，我们使用医疗保险管理索赔与最低数据集和 LTCF 级别的数据来确定短期入住（<100 天，指数=入院日期）和长期入住（100+天，指数=第 100 天）的居民，他们从指数日期开始随访，直到第一次住院、LTCF 出院、医疗保险退保或死亡。我们使用 Cox 回归模型测量每 100,000 人-天的 P&I 住院率，并根据基线人口统计学、老年综合征、临床特征和药物使用情况评估与住院率的相关性。
我们分析了 1,118,054 名短期和 593,443 名长期居民的数据。主要位置的 P&I 住院的粗 30 天发病率（95%CI）分别为短期和长期居民的 26.0（25.4，26.6）和 34.5（33.6，35.4）。与 P&I 相关的变量在短期和长期居民之间有所不同，常见的危险因素包括：85 岁以上、从急性医院入院、某些心血管和呼吸系统疾病、功能状态受损以及接受抗生素或 Beers 标准药物治疗。设施人员配备和护理质量措施是长期居民的重要危险因素，但在短期居民中并非如此。
与长期 LTCF 居民相比，短期居民的 P&I 住院的粗 30 天和 90 天发病率较低。短期和长期人群中 P&I 的危险因素差异表明，在 LTCF 中实施感染预防和控制策略时，考虑急性后和长期护理居民的不同特征非常重要。这些发现可以帮助临床医生针对 P&I 风险最高的 LTCF 居民亚组进行干预。
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