Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.
J Am Geriatr Soc. 2020 Jul;68(7):1512-1519. doi: 10.1111/jgs.16412. Epub 2020 Mar 18.
Medicare beneficiaries recovering from a critical illness are increasingly being discharged home instead of to post-acute care facilities. Rehabilitation services are commonly recommended for intensive care unit (ICU) survivors; however, little is known about the frequency and dose of home-based rehabilitation in this population.
Retrospective analysis of 2012 Medicare hospital and home health (HH) claims data, linked with assessment data from the Medicare Outcomes and Assessment Information Set.
Participant homes.
Medicare beneficiaries recovering from an ICU stay longer than 24 hours, who were discharged directly home with HH services within 7 days of discharge and survived without readmission or hospice transfer for at least 30 days (n = 3,176).
Count of rehabilitation visits received during HH care episode.
A total of 19,564 rehabilitation visits were delivered to ICU survivors over 118,145 person-days in HH settings, a rate of 1.16 visits per week. One-third of ICU survivors received no rehabilitation visits during HH care. In adjusted models, those with the highest baseline disability received 30% more visits (rate ratio [RR] = 1.30; 95% confidence interval [CI] = 1.17-1.45) than those with the least disability. Conversely, an inverse relationship was found between multimorbidity (Elixhauser scores) and count of rehabilitation visits received; those with the highest tertile of Elixhauser scores received 11% fewer visits (RR = .89; 95% CI = .81-.99) than those in the lowest tertile. Participants living in a rural setting (vs urban) received 6% fewer visits (RR = .94; 95% CI = .91-.98); those who lived alone received 11% fewer visits (RR = .89; 95% CI = .82-.96) than those who lived with others.
On average, Medicare beneficiaries discharged home after a critical illness receive few rehabilitation visits in the early post-hospitalization period. Those who had more comorbidities, who lived alone, or who lived in rural settings received even fewer visits, suggesting a need for their consideration during discharge planning. J Am Geriatr Soc 68:1512-1519, 2020.
越来越多从重病中康复的医疗保险受益人被直接出院回家，而不是去康复护理机构。重症监护病房（ICU）幸存者通常被推荐接受康复服务；然而，对于这一人群，家庭为基础的康复治疗的频率和剂量知之甚少。
对 2012 年医疗保险医院和家庭健康（HH）索赔数据进行回顾性分析，这些数据与医疗保险结果和评估信息集的评估数据相关联。
参与者家中。
从 ICU 住院时间超过 24 小时，出院后 7 天内直接出院并接受 HH 服务，且在至少 30 天内没有再次入院或转介到临终关怀（n = 3176）的医疗保险受益人。
在 HH 护理期间接受的康复治疗次数。
在 HH 环境中，共有 19564 次康复治疗用于 ICU 幸存者，共 118145 人天，每周治疗 1.16 次。三分之一的 ICU 幸存者在 HH 护理期间没有接受康复治疗。在调整后的模型中，那些基线残疾程度最高的人接受的治疗次数增加了 30%（比率比 [RR] = 1.30；95%置信区间 [CI] = 1.17-1.45），而那些残疾程度最低的人接受的治疗次数增加了 30%。相反，发现多发性疾病（Elixhauser 评分）与接受的康复治疗次数之间存在反比关系；在 Elixhauser 评分最高的 tertile 中，接受的治疗次数减少了 11%（RR =.89；95% CI = .81-.99），而在最低 tertile 中，接受的治疗次数减少了 11%（RR =.89；95% CI = .81-.99）。与城市相比，生活在农村地区（vs 城市）的人接受的治疗次数减少了 6%（RR =.94；95% CI = .91-.98）；与其他同住的人相比，独居的人接受的治疗次数减少了 11%（RR =.89；95% CI = .82-.96）。
平均而言，在重病后出院回家的医疗保险受益人在住院后早期接受的康复治疗次数较少。那些患有更多合并症、独居或生活在农村地区的人接受的治疗次数更少，这表明在出院计划时需要考虑到这些因素。美国老年医学会 68:1512-1519,2020。
