Duke University School of Medicine, Center for the Study of Aging and Human Development, DUMC, Box 3003, Durham, NC, 27710, USA.
Durham VA Geriatric Research Education and Clinical Center, Durham, NC, 27705, USA.
Aging Clin Exp Res. 2020 Dec;32(12):2595-2601. doi: 10.1007/s40520-020-01481-8. Epub 2020 Feb 14.
Administrative data sets lack functional measures.
We examined whether trajectories of cost can be used as a marker of functional recovery after hospitalization.
Secondary analysis of the National Health and Aging Trends Study merged with Centers for Medicare and Medicaid Services data. Community-dwelling participants with a first hospitalization occurring after any annual survey were included (N = 937). Monthly total cost trajectories were constructed for the 3 months before and 3 months following hospitalization. Growth mixture models identified groups of patients with similar trajectories. The association of cost classes with five functional outcomes was examined using multivariate models, controlling for pre-hospitalization function and lead time.
Four cost trajectory classes describing common recovery patterns were identified-persistently high, persistently moderate, low-spike-recover, and low variable. Cost class membership was significantly associated with change in Activities of Daily Living (ADL), instrumental ADL, Short Physical Performance Battery, and grip strength (p < 0.005), but not gait speed (p = 0.08). The proportion of patients who maintained or improved SPPB score was 46.8% in the persistently high, 49.2% in the persistently moderate, 52.7% in the low-spike-recover, and 57.2% in the low-variable groups. In models adjusted for known predictors of functional outcome, the magnitude and direction of association was maintained but significance was lost, indicating that cost trajectories' mirror is mediated by predictors of recovery not available in administrative data.
Cost trajectories and total costs are associated with functional recovery following hospitalization in older adults. Cost may be useful as a measure of recovery in administrative data.
行政数据集缺乏功能衡量指标。
我们研究了住院后成本轨迹是否可以作为功能恢复的标志。
对国家健康老龄化趋势研究与医疗保险和医疗补助服务中心数据进行二次分析。纳入首次住院发生在任何年度调查之后的居住在社区的参与者（N=937）。构建了住院前 3 个月和住院后 3 个月的每月总费用轨迹。增长混合模型确定了具有相似轨迹的患者群体。使用多元模型，在控制住院前功能和领先时间的情况下，检验费用类别与五个功能结果之间的关联。
确定了描述常见恢复模式的四种成本轨迹类别——持续高、持续中等、低峰值恢复和低变异性。费用类别成员资格与日常生活活动（ADL）、工具性 ADL、短体物理表现电池和握力的变化显著相关（p<0.005），但与步态速度无关（p=0.08）。在持续高、持续中等、低峰值恢复和低变异性组中，保持或改善 SPPB 评分的患者比例分别为 46.8%、49.2%、52.7%和 57.2%。在调整了功能结果的已知预测因素的模型中，关联的大小和方向得以维持，但意义丧失，表明成本轨迹的反映是由行政数据中不可用的恢复预测因素介导的。
成本轨迹和总成本与老年人住院后的功能恢复相关。在行政数据中，成本可能是衡量恢复的有用指标。
