家庭医疗保健的使用与心力衰竭住院后的出院结果。
Home Health Care Use and Post-Discharge Outcomes After Heart Failure Hospitalizations.
机构信息
Weill Cornell Medicine, New York, New York, USA.
Weill Cornell Medicine, New York, New York, USA.
出版信息
JACC Heart Fail. 2020 Dec;8(12):1038-1049. doi: 10.1016/j.jchf.2020.06.009. Epub 2020 Aug 12.
OBJECTIVES
This study compared the characteristics of Medicare beneficiaries who were hospitalized for heart failure (HF) and then discharged home who received home health care (HHC) to the characteristics of those who did not, and examined associations among HHC and readmission and mortality rates.
BACKGROUND
After hospitalization for HF, some patients receive HHC. However, the use of HHC over time, the factors associated with its use, and the post-discharge outcomes after receiving it are not well studied.
METHODS
This study used Get With The Guidelines-HF data, merged with Medicare fee-for-service claims. Propensity score matching and Cox proportional hazards models were used to evaluate the associations between HHC and post-discharge outcomes.
RESULTS
From 2005 to 2015, 95,531 patients were admitted for HF, and 32,697 (34.2%) received HHC after discharge. The rate of HHC increased over time from 31.4% to 36.1% (p < 0.001). HHC recipients were older, more likely to be female, and had more comorbidities. HHC was associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.20 to 1.30), HF-specific 30-day readmission (HR: 1.20; 95% CI: 1.13 to 1.28), all-cause 90-day readmission (HR: 1.23; 95% CI: 1.19 to 1.26), HF-specific 90-day readmission (HR: 1.16; 95% CI: 1.11 to 1.22), and all-cause 30-and 90-day mortality, respectively (HR: 1.70; 95% CI: 1.56 to 1.86) and HR: 1.49; 95% CI: 1.41 to 1.57) compared to those who did not receive HHC.
CONCLUSIONS
Use of HHC after HF hospitalization increased among Medicare beneficiaries. HHC recipients were older and sicker than non-HHC recipients. Although HHC was associated with a higher risk of readmissions and mortality, this finding should be interpreted cautiously, given the presence of unmeasured variables that could affect receipt of HHC. Research is needed to determine whether the results reflect appropriate health care use.
目的
本研究比较了因心力衰竭（HF）住院后出院回家并接受家庭保健（HHC）和未接受 HHC 的患者的特征，并探讨了 HHC 与再入院率和死亡率之间的关系。
背景
HF 住院后，部分患者接受 HHC。然而，HHC 的使用时间、与其相关的因素以及接受 HHC 后的出院后结局并未得到充分研究。
方法
本研究使用 Get With The Guidelines-HF 数据，并与 Medicare 按服务收费索赔合并。采用倾向评分匹配和 Cox 比例风险模型评估 HHC 与出院后结局之间的关系。
结果
2005 年至 2015 年，95531 名患者因 HF 入院，其中 32697 名（34.2%）在出院后接受 HHC。HHC 的使用率随时间推移从 31.4%增加到 36.1%（p<0.001）。HHC 接受者年龄较大，更可能为女性，且合并症更多。HHC 与全因 30 天再入院（风险比[HR]：1.25；95%置信区间[CI]：1.20 至 1.30）、HF 特异性 30 天再入院（HR：1.20；95%CI：1.13 至 1.28）、全因 90 天再入院（HR：1.23；95%CI：1.19 至 1.26）、HF 特异性 90 天再入院（HR：1.16；95%CI：1.11 至 1.22）、全因 30 天和 90 天死亡率（HR：1.70；95%CI：1.56 至 1.86）和 HR：1.49；95%CI：1.41 至 1.57）分别升高。
结论
在 Medicare 受益人群中，HF 住院后使用 HHC 的比例增加。HHC 接受者比非 HHC 接受者年龄更大，病情更严重。尽管 HHC 与再入院率和死亡率升高有关，但鉴于可能影响 HHC 接受的未测量变量的存在，应谨慎解释这一发现。需要研究以确定这些结果是否反映了适当的医疗保健使用。
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