德国功能定义人群的养老院入院差异及其与医疗保健质量的关系。
Differences in nursing home admission between functionally defined populations in Germany and the association with quality of health care.
机构信息
Institute for Public Health and Nursing Research, Faculty 11: Human and Health Sciences, University of Bremen, Bremen, Germany.
High Profile Area Health Sciences, University of Bremen, Bremen, Germany.
出版信息
BMC Health Serv Res. 2021 Mar 2;21(1):190. doi: 10.1186/s12913-021-06196-8.
BACKGROUND
People prefer to age in place and not move into a nursing home as long as possible. The prevention of cognitive and functional impairments is feasible to support this goal. Health services play a key role in providing support for underlying medical conditions. We examined differentials in nursing home admissions between patient sharing networks in Germany and whether potential variations can be attributed to indicators of health care provision.
METHODS
We conducted an ecological study using data of patients of 65 years and above from all 11 AOK statutory health insurance companies in Germany. Nursing home admissions were observed in a cohort of persons becoming initially care-dependent in 2006 (n = 118,213) with a follow-up of up to 10 years. A patient sharing network was constructed and indicators for quality of health care were calculated based on data of up to 6.6 million patients per year. Community detection was applied to gain distinct patient populations. Analyses were conducted descriptively and through regression analyses to identify the variation explained by included quality indicators.
RESULTS
The difference in the proportion of nursing home admissions between identified clusters shows an interquartile range (IQR) of 12.6% and the average time between onset of care-dependency and admission to a nursing home an IQR of 10,4 quarters. Included quality indicators attributed for 40% of these variations for the proportion of nursing home admissions and 49% for the time until nursing home admission, respectively. Indicators of process quality showed the single highest contribution. Effects of single indicators were inconclusive.
CONCLUSIONS
Health services can support persons in their preference to age in place. Research and discussion on adequate health care for care-dependent persons and on conditions, where nursing home admission may be beneficial, is necessary.
背景
人们希望尽可能长时间地在自己熟悉的地方安度晚年，而不是搬入养老院。预防认知和功能障碍是实现这一目标的可行方法。卫生服务在为潜在疾病提供支持方面发挥着关键作用。我们研究了德国患者共享网络之间的养老院入院差异，以及潜在的差异是否可以归因于卫生保健提供指标。
方法
我们使用了德国所有 11 家 AOK 法定健康保险公司的 65 岁及以上患者的数据，开展了一项生态研究。在 2006 年首次出现依赖护理的人群队列中观察养老院入院情况（n=118213），随访时间长达 10 年。构建了一个患者共享网络，并根据每年多达 660 万患者的数据计算了卫生保健质量指标。采用社区检测方法获得不同的患者群体。通过描述性分析和回归分析来识别纳入的质量指标所解释的差异。
结果
在确定的聚类中，养老院入院比例的差异显示出 12.6%的四分位距（IQR），从依赖护理开始到入住养老院的平均时间为 10.4 个季度的 IQR。纳入的质量指标分别解释了养老院入院比例差异的 40%和入住养老院时间差异的 49%。过程质量指标的贡献最大。单一指标的影响尚无定论。
结论
卫生服务可以支持人们在自己熟悉的地方安度晚年。有必要对依赖护理的人群进行适当的卫生保健研究和讨论，并探讨养老院入院可能有益的条件。
Zotero 插件