Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
J Am Geriatr Soc. 2021 Jun;69(6):1601-1608. doi: 10.1111/jgs.17065. Epub 2021 Mar 6.
BACKGROUND/OBJECTIVES: Rates of traumatic brain injury (TBI) among older adults and treatment of this population in nursing homes are increasing. The objective of this study is to examine differences in the quality of care and outcomes of older adults with TBI in rural and urban settings by (1) comparing the rates of successful community discharge; and (2) reasons for not achieving successful discharge among patients in rural and urban environments.
Retrospective national cohort study of skilled nursing facility (SNF) patients using Medicare inpatient claims linked with Minimum Data Set assessments. Demographic, health, and facility characteristics were compared between rural and urban settings using descriptive statistics. Logistic regression with state random effects was used to identify characteristics that predicted successful discharge.
U.S. skilled nursing facilities (n = 11,771).
Medicare beneficiaries aged 66 and older discharged to a SNF following hospitalization for TBI between 2011 and 2015 (n = 61,021).
Successful community discharge defined as discharge from SNF within 100 days of admission and remaining in the community for ≥30 days without dying or admission to an inpatient healthcare facility.
Unadjusted rates of successful discharge were significantly lower for patients in rural settings compared with patients in urban settings (52.1% vs 58.5%, p < 0.01). Patients in rural settings had lower adjusted odds (odds ratio 0.84, 95% confidence interval = 0.80-0.89) of successful discharge. Reasons for not discharging successfully differed between rural and urban settings with rural patients less likely to discharge from SNF within 100 days though also less likely to be rehospitalized within 30 days of SNF discharge.
Given the low overall rate of successful community discharge and worse outcomes among rural patients, further research to explore interventions to improve SNF care and discharge planning in this population is warranted.
背景/目的：老年人创伤性脑损伤（TBI）的发生率以及疗养院中这一人群的治疗方法正在增加。本研究的目的是通过（1）比较农村和城市环境中 TBI 老年患者成功社区出院率；以及（2）比较农村和城市环境中患者无法成功出院的原因，来检查农村和城市环境中老年人 TBI 护理质量和结果的差异。
这是一项利用医疗保险住院索赔与最低数据评估相联系，对熟练护理设施（SNF）患者进行的回顾性全国队列研究。使用描述性统计方法比较农村和城市环境中的人口统计学、健康和设施特征。使用州随机效应的逻辑回归来确定预测成功出院的特征。
美国熟练护理设施（n=11771）。
2011 年至 2015 年期间因 TBI 住院后出院至 SNF 的年龄在 66 岁及以上的医疗保险受益人（n=61021）。
成功的社区出院定义为在入院后 100 天内从 SNF 出院，并在社区中至少存活 30 天，没有死亡或入住住院医疗设施。
与城市环境中的患者相比，农村环境中的患者未经调整的成功出院率明显较低（52.1%对 58.5%，p<0.01）。农村环境中的患者成功出院的调整后优势比（比值比 0.84，95%置信区间为 0.80-0.89）较低。农村和城市环境之间出院不成功的原因不同，农村患者在 100 天内从 SNF 出院的可能性较低，但 SNF 出院后 30 天内再次住院的可能性也较低。
鉴于农村患者总体社区成功出院率较低，且预后较差，需要进一步研究探索改善这一人群 SNF 护理和出院计划的干预措施。
