From the Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea (IH); Department of Physical Therapy, MGH Institute of Health Professions, Boston, Massachusetts (SK); Department of Occupational Therapy, University of Texas Medical Branch, Galveston, Texas (LP, MFS); Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (TMM); Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado (JEG); and School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, Texas (TAR).
Am J Phys Med Rehabil. 2020 Sep;99(9):837-841. doi: 10.1097/PHM.0000000000001435.
We examined the association between home health rehabilitation referral and 90-day risk-adjusted hospital readmission after discharge from inpatient rehabilitation facilities among adult patients recovering from stroke (N = 1219).
A secondary data analysis of the 2005-2006 Stroke Recovery in Underserved Population database. A logistic regression model, multilevel model, and the propensity score inverse probability weighting model were used to evaluate the risk of 90-day rehospitalization between patients with stroke who received a referral for home health rehabilitation and those who did not receive a home health rehabilitation referral at inpatient rehabilitation facility discharge.
The regression, multilevel, and propensity score inverse probability weighting models indicated that inpatient rehabilitation facility patients with stroke who received home health rehabilitation referral had substantially lower odds of 90-day rehospitalization after inpatient rehabilitation facility discharge compared with those who were not referred to home health (odds ratio = 0.325, 95% confidence interval = 0.138-0.764; odds ratio = 0.340, 95% confidence interval = 0.139-0.832; odds ratio = 0.407, 95% confidence interval = 0.183-0.906, respectively).
Our findings suggest the importance of continuation of care (home health) after hospitalization and intense inpatient rehabilitation for stroke. Additional research is needed to establish appropriate use criteria and explore potential underuse of home health services as well as the benefits for follow-up outpatient services for those who do not qualify for home health at inpatient rehabilitation facility discharge.
我们研究了在住院康复机构出院的成人中风患者（N=1219）中，家庭康复转介与 90 天风险调整后再入院之间的关系。
对 2005-2006 年服务不足人群中风恢复数据库的二次数据分析。使用逻辑回归模型、多层次模型和倾向评分逆概率加权模型来评估在住院康复机构出院时接受家庭康复转介和未接受家庭康复转介的中风患者 90 天再入院的风险。
回归、多层次和倾向评分逆概率加权模型表明，接受家庭康复转介的中风住院康复机构患者在住院康复机构出院后 90 天内再入院的可能性显著低于未转介至家庭康复的患者（比值比=0.325，95%置信区间=0.138-0.764；比值比=0.340，95%置信区间=0.139-0.832；比值比=0.407，95%置信区间=0.183-0.906）。
我们的研究结果表明，中风患者住院后和强化住院康复后继续治疗（家庭康复）的重要性。需要进一步研究以确定适当的使用标准，并探讨家庭健康服务潜在的使用不足，以及对于那些不符合住院康复机构出院后家庭健康条件的患者，后续门诊服务的获益。
