2010 年医疗保险改革与缺血性脑卒中患者接受住院康复治疗的利用度之间的关联。
Association Between 2010 Medicare Reforms and Utilization of Postacute Inpatient Rehabilitation in Ischemic Stroke.
机构信息
From the Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas (NLI); Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas (NLI); Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas (NLI); Centers for Outcomes Research, Houston Methodist Research Institute, Houston, Texas (FV); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, Lansing, Michigan (MR); Department of Neurology, Duke University Hospital, Durham, North Carolina (YX); Duke Clinical Research Institute, Durham, North Carolina (YX, LL, RM); Division of Cardiology, Ahmanson - UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California (GCF); Institute for Stroke and Cerebrovascular Disease, UTHealth, Houston, Texas (SIS); and Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas (SIS).
出版信息
Am J Phys Med Rehabil. 2021 Jul 1;100(7):675-682. doi: 10.1097/PHM.0000000000001605.
OBJECTIVE
The aim of the study was to investigate whether the elimination of trial admissions and the initiation of documentation requirements, via the 2010 Centers for Medicare and Medicaid Services Inpatient Rehabilitation Facility Prospective Payment System Rule, limited inpatient rehabilitation facility access while increasing skilled nursing facility utilization compared with home discharge in ischemic stroke patients.
DESIGN
This is a retrospective observational study using Get with the Guidelines - Stroke hospital data between January 1, 2008 and December 31, 2015 (N = 1,643,553).
RESULTS
Between January 1, 2008 and December 31, 2009, 54.1% of patients went home, 25.4% to inpatient rehabilitation facility and 20.5% to skilled nursing facility. Between January 1, 2010 and December 31, 2015, there was a 1.4% absolute increase in home discharge, a 1.1% inpatient rehabilitation facility decline and a 0.3% skilled nursing facility decline.Within the 1.1% absolute decline in inpatient rehabilitation facility discharge, the adjusted odds of inpatient rehabilitation facility versus home discharge decreased 12% after 2010 Rule (adjusted odds ratio = 0.88, 95% confidence interval = 0.87-0.89, P < 0.0001). There was no statistically significant change in skilled nursing facility versus home discharge.Lower adjusted odds of inpatient rehabilitation facility discharge versus home discharge were identical across age groups and were present in all geographic regions.
CONCLUSIONS
In populations with ischemic stroke, the Centers for Medicare and Medicaid Services 2010 Inpatient Rehabilitation Facility Prospective Payment System Rule was associated with a 1.1% absolute decrease in inpatient rehabilitation facility discharge, with a concomitant increase in home discharge rather than to skilled nursing facility.
目的
本研究旨在探讨 2010 年医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）的住院康复设施按床日付费制规则（Inpatient Rehabilitation Facility Prospective Payment System Rule）是否通过取消试住和增加文件要求，限制了缺血性脑卒中患者入住住院康复设施的机会，同时增加了他们入住熟练护理设施的比例，而非选择出院回家。
设计
这是一项使用 Get with the Guidelines-Stroke 医院数据进行的回顾性观察性研究，时间范围为 2008 年 1 月 1 日至 2015 年 12 月 31 日（N=1,643,553）。
结果
在 2008 年 1 月 1 日至 2009 年 12 月 31 日期间，54.1%的患者出院回家，25.4%的患者入住住院康复设施，20.5%的患者入住熟练护理设施。在 2010 年 1 月 1 日至 2015 年 12 月 31 日期间，出院回家的患者比例绝对增加了 1.4%，住院康复设施的患者比例下降了 1.1%，熟练护理设施的患者比例下降了 0.3%。在住院康复设施出院人数绝对下降的 1.1%中，2010 年规则后，住院康复设施与回家出院相比，调整后的优势比（odds ratio，OR）下降了 12%（调整后 OR=0.88，95%置信区间=0.87-0.89，P<0.0001）。熟练护理设施与回家出院相比，OR 没有统计学意义上的变化。在各个年龄组和所有地理区域，住院康复设施出院的调整后 OR 均低于回家出院，且差异具有统计学意义。
结论
在患有缺血性脑卒中的人群中，医疗保险和医疗补助服务中心 2010 年住院康复设施按床日付费制规则与住院康复设施出院人数绝对减少 1.1%相关，同时增加了患者出院回家的比例，而不是去熟练护理设施。
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