美国老年人在医院服务区的急性后期护理使用模式：一项横断面研究。
Post-acute care use patterns among Hospital Service Areas by older adults in the United States: a cross-sectional study.
作者信息
Dean Julianna M, Hreha Kimberly, Hong Ickpyo, Li Chih-Ying, Jupiter Daniel, Prochaska John, Reistetter Timothy
机构信息
University of Houston-Clear Lake, 2700 Bay Area Blvd, Houston, TX, 77058, USA.
University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
出版信息
BMC Health Serv Res. 2021 Feb 25;21(1):176. doi: 10.1186/s12913-021-06159-z.
BACKGROUND
Despite the success of stroke rehabilitation services, differences in service utilization exist. Some patients with stroke may travel across regions to receive necessary care prescribed by their physician. It is unknown how availability and combinations of post-acute care facilities in local healthcare markets influence use patterns. We present the distribution of skilled nursing, inpatient rehabilitation, and long-term care hospital services across Hospital Service Areas among a national stroke cohort, and we describe drivers of post-acute care service use.
METHODS
We extracted data from 2013 to 2014 of a national stroke cohort using Medicare beneficiaries (174,498 total records across 3232 Hospital Service Areas). Patients' ZIP code of residence was linked to the facility ZIP code where care was received. If the patient did not live in the Hospital Service Area where they received care, they were considered a "traveler". We performed multivariable logistic regression to regress traveling status on the care combinations available where the patient lived.
RESULTS
Although 73.4% of all Hospital Service Areas were skilled nursing-only, only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas; 40.8% of all patients received care in Hospital Service Areas with only inpatient rehabilitation and skilled nursing, which represented only 18.2% of all Hospital Service Areas. Thirty-five percent of patients traveled to a different Hospital Service Area from where they lived. Regarding "travelers," for those living in a skilled nursing-only Hospital Service Area, 49.9% traveled for care to Hospital Service Areas with only inpatient rehabilitation and skilled nursing. Patients living in skilled nursing-only Hospital Service Areas had more than five times higher odds of traveling compared to those living in Hospital Service Areas with all three facilities.
CONCLUSIONS
Geographically, the vast majority of Hospital Service Areas in the United States that provided rehabilitation services for stroke survivors were skilled nursing-only. However, only about one-third lived in skilled nursing-only Hospital Service Areas; over 35% traveled to receive care. Geographic variation exists in post-acute care; this study provides a foundation to better quantify its drivers. This study presents previously undescribed drivers of variation in post-acute care service utilization among Medicare beneficiaries-the "traveler effect".
背景
尽管中风康复服务取得了成功，但服务利用情况仍存在差异。一些中风患者可能会跨地区就医，以接受医生开具的必要治疗。目前尚不清楚当地医疗市场中急性后期护理设施的可及性和组合方式如何影响使用模式。我们展示了全国中风队列中各医院服务区内专业护理、住院康复和长期护理医院服务的分布情况，并描述了急性后期护理服务使用的驱动因素。
方法
我们从2013年至2014年的全国中风队列中提取了使用医疗保险受益人的数据（3232个医院服务区共有174498条记录）。患者的居住邮政编码与接受治疗的设施邮政编码相关联。如果患者不住在接受治疗的医院服务区，则被视为“就医旅行者”。我们进行了多变量逻辑回归，以患者居住地区可获得的护理组合为自变量，以就医旅行状态为因变量进行回归分析。
结果
尽管所有医院服务区中有73.4%仅提供专业护理服务，但所有患者中只有23.5%在仅提供专业护理服务的医院服务区接受治疗；所有患者中有40.8%在仅提供住院康复和专业护理服务的医院服务区接受治疗，而这些服务区仅占所有医院服务区的18.2%。35%的患者前往与居住地区不同的医院服务区就医。对于“就医旅行者”来说，那些居住在仅提供专业护理服务的医院服务区的患者中，49.9%前往仅提供住院康复和专业护理服务的医院服务区就医。与居住在拥有所有三种设施的医院服务区的患者相比，居住在仅提供专业护理服务的医院服务区的患者就医旅行的几率高出五倍多。
结论
从地理角度来看，美国为中风幸存者提供康复服务的绝大多数医院服务区仅提供专业护理服务。然而，只有约三分之一的患者居住在仅提供专业护理服务的医院服务区；超过35%的患者需要前往其他地区接受治疗。急性后期护理存在地理差异；本研究为更好地量化其驱动因素提供了基础。本研究揭示了医疗保险受益人中此前未被描述的急性后期护理服务利用差异的驱动因素——“就医旅行者效应”。
Zotero 插件