Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown School of Public Health, Providence, RI.
Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown School of Public Health, Providence, RI.
Arch Phys Med Rehabil. 2021 Mar;102(3):480-487. doi: 10.1016/j.apmr.2020.09.375. Epub 2020 Sep 28.
To examine the association of patient and direct-care staff beliefs about patients' capability to increase independence with activities of daily living (ADL) and the probability of successful discharge to the community after a skilled nursing facility (SNF) stay.
Retrospective cohort study of SNF patients using 100% Medicare inpatient claims and Minimum Data Set resident assessment data. Linear probability models were used to estimate the probability of successful discharge based on patient and staff beliefs about the patient's ability to improve in function, as well as patient and staff beliefs together. Estimates were adjusted for demographics, health status, functional characteristics, and SNF fixed effects.
Fee-for-service Medicare beneficiaries (N=526,432) aged 66 years or older who were discharged to an SNF after hospitalization for stroke, hip fracture, or traumatic brain injury.
Not applicable.
Successful community discharge (discharged alive within 90d of SNF admission and remaining in the community for ≥30d without dying or health care facility readmission).
Patients with positive beliefs about their capability to increase independence with ADLs had a higher adjusted probability of successful discharge than patients with negative beliefs (positive, 63.8%; negative, 57.8%; difference, 6.0%, 95% confidence interval [CI], 5.4-6.6). This remained true regardless of staff beliefs, but the difference in successful discharge probability between patients with positive and negative beliefs was larger when staff had positive beliefs. Conversely, the association between staff beliefs and successful discharge varied based on patient beliefs. If patients had positive beliefs, the difference in the probability of successful discharge between positive and negative staff beliefs was 2.5% (95% CI, 1.0-4.0). If patients had negative beliefs, the difference between positive and negative staff beliefs was -4.6% (95% CI, -6.0 to -3.2).
Patients' beliefs have a significant association with the probability of successful discharge. Understanding patients' beliefs is critical to appropriate goal-setting, discharge planning, and quality SNF care.
探讨患者和直接护理人员对患者增加独立性能力的信念与日常生活活动（ADL）的关系，以及在熟练护理机构（SNF）住院后成功出院到社区的概率。
使用 100%的医疗保险住院患者索赔和最低数据集中的居民评估数据对 SNF 患者进行回顾性队列研究。线性概率模型用于根据患者和工作人员对患者功能改善能力的信念以及患者和工作人员的信念来估计成功出院的概率。估计值根据人口统计学、健康状况、功能特征和 SNF 固定效应进行调整。
66 岁或以上的 SNF 接受者，他们在因中风、髋部骨折或创伤性脑损伤住院后出院到 SNF。
不适用。
成功的社区出院（在 SNF 入院后 90 天内活着出院，并且在没有死亡或医疗机构重新入院的情况下在社区中至少 30 天）。
对 ADL 增加独立性能力有积极信念的患者比有消极信念的患者有更高的调整后成功出院概率（积极信念，63.8%；消极信念，57.8%；差异，6.0%，95%置信区间[CI]，5.4-6.6）。这是正确的，无论工作人员的信念如何，但当工作人员有积极的信念时，具有积极和消极信念的患者之间成功出院的概率差异更大。相反，工作人员信念与成功出院之间的关联取决于患者的信念。如果患者有积极的信念，那么积极和消极工作人员信念之间成功出院的概率差异为 2.5%（95%CI，1.0-4.0）。如果患者有消极的信念，那么积极和消极工作人员信念之间的差异为-4.6%（95%CI，-6.0 至-3.2）。
患者的信念与成功出院的概率有显著的关联。了解患者的信念是适当的目标设定、出院计划和高质量 SNF 护理的关键。
