Simning Adam, Orth Jessica, Caprio Thomas V, Li Yue, Wang Jinjiao, Temkin-Greener Helena
Department of Psychiatry, University of Rochester, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
J Am Med Dir Assoc. 2021 Mar;22(3):701-705.e1. doi: 10.1016/j.jamda.2020.09.016. Epub 2020 Oct 26.
Our study examined the proportion of skilled nursing facility (SNF) post-acute care residents who did not receive timely primary care provider (PCP) services following discharge, factors associated with lack of timely PCP services, and factors associated with perfect 30-day home time among those who did not receive timely PCP services.
Longitudinal cohort study; data sources included Medicare claims and other administrative databases.
25,357 fee-for-service New York State Medicare beneficiaries aged 65 years and older admitted to SNFs for post-acute care in 2014 and then discharged to the community.
Our outcomes were a timely PCP visit (within 7 days of SNF discharge) and perfect 30-day home time, and we examined their association with patient, SNF, and county factors.
Among SNF discharges, 60.6% had a timely PCP visit. In multivariate regression analyses, female sex, nonwhite race, Medicare only status, less functional impairment and medical comorbidity, a surgical hospitalization, fewer hospital days, more SNF days, absence of home health services, for-profit SNF status, higher SNF star rating, lower ratio of registered nurse/total nursing hours, and rural counties were associated with lower odds of a timely PCP visit following SNF discharge. Among those without a timely PCP visit, female sex, less cognitive and functional impairment, less medical comorbidity, a surgical hospitalization, fewer hospital days, receipt of home health services, and higher SNF star rating were associated with increased odds of perfect 30-day home time following SNF discharge.
That 4 in 10 post-acute care SNF patients did not have a timely PCP visit post-SNF discharge, with racial minority and rural county status associated with decreased odds of a timely PCP visit, is concerning. Examination of whether the timing and type of outpatient visit may have varying effects on different post-acute care subpopulations would build on this work.
我们的研究调查了专业护理机构（SNF）急性后期护理居民出院后未及时获得初级保健提供者（PCP）服务的比例、与未及时获得PCP服务相关的因素，以及在未及时获得PCP服务的人群中与30天完美居家时间相关的因素。
纵向队列研究；数据来源包括医疗保险索赔和其他行政数据库。
2014年因急性后期护理入住SNFs然后出院至社区的25357名纽约州65岁及以上按服务收费的医疗保险受益人。
我们的结局指标是及时的PCP就诊（SNF出院后7天内）和30天完美居家时间，我们研究了它们与患者、SNF和县域因素的关联。
在SNF出院患者中，60.6%有及时的PCP就诊。在多变量回归分析中，女性、非白人种族、仅拥有医疗保险状态、功能障碍和医疗合并症较少、手术住院、住院天数较少、SNF天数较多、没有家庭健康服务、营利性SNF状态、SNF星级较高、注册护士/总护理小时数较低以及农村县与SNF出院后及时PCP就诊的较低几率相关。在未及时进行PCP就诊的人群中，女性、认知和功能障碍较少、医疗合并症较少、手术住院、住院天数较少、接受家庭健康服务以及SNF星级较高与SNF出院后30天完美居家时间的较高几率相关。
十分之四的急性后期护理SNF患者在SNF出院后没有及时进行PCP就诊，少数族裔和农村县状态与及时PCP就诊的较低几率相关，这令人担忧。在此基础上，研究门诊就诊的时间和类型是否可能对不同的急性后期护理亚人群产生不同影响。
