Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA.
Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
PM R. 2021 Nov;13(11):1227-1236. doi: 10.1002/pmrj.12563. Epub 2021 Apr 5.
Although general physiatry acute-care consultation services are commonplace and improve length of stay (LOS), the benefits of a subspecialty physiatric continuity consultation service targeting patients with severe brain injury have not been reported.
Our primary objective was to characterize patient care recommendations from a Brain Injury Medicine (BIM) Continuity Consult Service, and to investigate the effects on acute-care LOS relative to brain injury patients receiving General Physical Medicine & Rehabilitation (PM&R) Consult Services. Our secondary objectives were to examine inpatient rehabilitation (IPR) health care utilization metrics and costs between groups and evaluate clinical improvements during IPR and discharge disposition.
Retrospective cohort comparison study.
Academic medical center with level 1 trauma center.
Adults with severe brain injury admitted to a single-site acute-care facility and subsequently admitted to a single inpatient brain injury rehabilitation unit over the same time period.
BIM Continuity Consult Service versus General PM&R Consult Service.
Acute-care LOS; unplanned discharges to acute-care.
Despite no major demographic or clinical group differences, the BIM Consult Service had more patient comorbidities than General PM&R Consult Service (17.5±5.3 versus 16±5.1;P = .04). BIM Consult Service patients spent fewer days in acute care (30±11.8 versus 36±22.8; P = .008), and early BIM consult (≤7 days after admission) was associated with shorter acute-care LOS (P < .002). IPR LOS was similar between groups when considering unplanned transfers. Unplanned transfers among General PM&R Consult Service patients occurred twice as frequently as in BIM Consult Service patients; average readmission costs were $2778 per patient on the BIM Consult Service and $6702 per patient on the General PM&R Consult Service. More BIM Consult Service (85.7%) than General PM&R Consult Service (27.3%) patients emerged from disorders of consciousness during IPR (P = .02).
BIM Continuity Consultation Services were associated with shorter acute-care LOS, fewer unplanned acute-care transfers, and an increased likelihood of emerging from a minimally conscious state during IPR.
尽管普通物理医学急性护理咨询服务很常见，并能延长住院时间（LOS），但针对严重脑损伤患者的亚专业物理医学连续性咨询服务的益处尚未得到报道。
我们的主要目标是描述脑损伤医学（BIM）连续性咨询服务的患者护理建议，并研究其与接受普通物理医学和康复（PM&R）咨询服务的脑损伤患者的急性护理 LOS 变化的关系。我们的次要目标是检查两组之间的住院康复（IPR）医疗保健利用指标和成本，并评估 IPR 和出院处置期间的临床改善。
回顾性队列比较研究。
具有 1 级创伤中心的学术医疗中心。
在同一时期内，因严重脑损伤而入住单站点急性护理机构，随后入住单一会员脑损伤康复单位的成年人。
BIM 连续性咨询服务与普通 PM&R 咨询服务。
急性护理 LOS；非计划性返回急性护理。
尽管在主要人口统计学或临床分组方面没有差异，但 BIM 咨询服务的患者合并症比普通 PM&R 咨询服务更多（17.5±5.3 与 16±5.1；P=0.04）。BIM 咨询服务的患者在急性护理中花费的时间更少（30±11.8 与 36±22.8；P=0.008），并且早期 BIM 咨询（入院后≤7 天）与急性护理 LOS 较短相关（P<0.002）。当考虑非计划性转移时，两组之间的 IPR LOS 相似。普通 PM&R 咨询服务患者的非计划性转移发生率是 BIM 咨询服务患者的两倍；BIM 咨询服务患者的平均再入院费用为每位患者 2778 美元，而普通 PM&R 咨询服务患者为每位患者 6702 美元。在 IPR 期间，更多的 BIM 咨询服务（85.7%）患者从意识障碍中恢复，而普通 PM&R 咨询服务（27.3%）患者（P=0.02）。
BIM 连续性咨询服务与急性护理 LOS 缩短、非计划性急性护理转移减少以及 IPR 期间从最小意识状态中恢复的可能性增加有关。
