Warren Alpert Medical School of Brown University, Providence, RI, United States of America.
PLoS One. 2020 Oct 12;15(10):e0240624. doi: 10.1371/journal.pone.0240624. eCollection 2020.
There is increasing demand for post-acute care services, which is amplified by the COVID-19 pandemic.
We studied the pattern of spatial association between post-acute care services and acute care facilities and evaluated how geographic variability could influence their use.
We compiled data on CMS-certified acute care and critical access hospitals and post-acute health care services (nursing homes, home health care services, inpatient rehabilitation facilities, long-term care hospitals, and hospice facilities). We used the colocation quotient (CLQ) to measure the magnitude and direction of association (clustering or segregation) between post-acute care providers and hospitals. This metric allows pairwise comparison of categorical data; a value <1 indicates spatial segregation and a value >1 spatial clustering. Unity marks the lack of spatial dependence (random distribution).
With the exception of nursing homes (CLQ 1.26), all other types of post-acute care providers are spatially segregated from rural critical access hospitals. Long-term care facilities ranked first (had the lowest global CLQ, 0.06), hospice facilities ranked last (had the highest global CLQ estimate, 0.54). Instead, post-acute care services either clustered with (inpatient rehabilitation 2.76, long-term care 2.10, nursing homes 1.37) or were only weakly segregated (home health care 0.86) from acute care hospitals. Home health care (1.44), hospice services (1.46), and nursing homes (1.08) spatially clustered with the same category of services. Results were robust in the sensitivity analysis and we provided illustrative examples of local variation for the states of MA and IA.
Post-acute care services are isolated from critical access hospitals, and have a clustering pattern with the same category services and acute care hospitals. Such misdistribution of resources may result in both underuse and a substitution effect on the type of post-acute care between rural and urban areas and undermine public health during increasing demand, such as the COVID-19 pandemic.
由于 COVID-19 大流行，对急性后护理服务的需求不断增加。
我们研究了急性护理设施和急性后护理服务（疗养院、家庭保健服务、住院康复设施、长期护理医院和临终关怀设施）之间的空间关联模式，并评估了地理变异性如何影响它们的使用。
我们编制了 CMS 认证的急性护理和关键访问医院以及急性后医疗保健服务的数据。我们使用共定位商数（CLQ）来衡量急性后护理提供者和医院之间关联的大小和方向（聚类或隔离）。该指标允许对分类数据进行成对比较；值<1 表示空间隔离，值>1 表示空间聚类。1 表示缺乏空间依赖性（随机分布）。
除了疗养院（CLQ 1.26）之外，所有其他类型的急性后护理提供者与农村关键访问医院在空间上是隔离的。长期护理机构排名第一（全球 CLQ 最低，为 0.06），临终关怀机构排名最后（全球 CLQ 最高，为 0.54）。相反，急性后护理服务要么与（住院康复 2.76、长期护理 2.10、疗养院 1.37）聚类，要么与急性护理医院只有微弱的隔离（家庭保健 0.86）。家庭保健（1.44）、临终关怀服务（1.46）和疗养院（1.08）与同一类服务在空间上聚类。敏感性分析结果稳健，我们还为马萨诸塞州和爱荷华州的局部变化提供了说明性示例。
急性后护理服务与关键访问医院隔离，并且与同一类服务和急性护理医院具有聚类模式。这种资源分配不当可能会导致农村和城市地区之间的急性后护理类型的使用不足和替代效应，并在需求增加（如 COVID-19 大流行期间）时损害公共卫生。
