Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Am Geriatr Soc. 2021 Oct;69(10):2899-2907. doi: 10.1111/jgs.17321. Epub 2021 Jun 25.
More than 600,000 Medicare beneficiaries with a diagnosis of dementia are discharged to skilled nursing facilities (SNFs) after hospitalization annually. However, it is unclear how their risks and benefits of a SNF stay compare to beneficiaries without a diagnosis of dementia.
Retrospective analysis comparing SNF outcomes for Medicare beneficiaries with and without a diagnosis of dementia.
One hundred percent sample of Medicare beneficiaries from 2015 to 2016.
Dementia was identified using validated diagnosis codes. In beneficiaries who had an acute hospitalization followed by SNF stay, we used propensity score matching to balance demographics, comorbidities, characteristics of the index hospital stay, prior hospital and SNF utilization, and cognitive status on SNF admission.
Outcomes included unplanned hospital readmission, community discharge rate, and mortality during the SNF stay. Multivariate models were adjusted for hospital and SNF characteristics.
Our sample included 2,418,853 Medicare beneficiaries discharged from hospital to SNF; 830,524 (34.3%) carried a diagnosis of dementia. Overall, 14.7% of the sample had a hospital readmission, 5.0% died, and 61.5% were successfully discharged to the community. In the propensity-matched cohort, beneficiaries with a diagnosis of dementia had a lower odds ratio of mortality (OR 0.87; 95% confidence interval [CI] 0.86-0.89), similar odds of hospital readmission (OR 0.99; 95% CI 0.98-1.00), and reduced odds of discharge to the community (OR 0.92; 95% CI 0.91-0.93). However, these findings varied by the severity of cognitive impairment on SNF admission: in beneficiaries with no impairment, those with a diagnosis of dementia had higher odds of adverse outcomes. In beneficiaries with severe impairment, beneficiaries with a diagnosis of dementia had lower odds of adverse outcomes.
Cognitive dysfunction on SNF admission is a stronger predictor of outcomes than a diagnosis of dementia, suggesting the need to individualize decisions about the benefits and risks of SNF care in populations with cognitive impairment.
每年有超过 60 万患有痴呆症的医疗保险受益人在住院后被送往熟练护理机构（SNF）。然而，目前尚不清楚他们在 SNF 停留期间的风险和收益与没有痴呆症诊断的受益人相比如何。
比较医疗保险受益人与痴呆症诊断的 SNF 结果的回顾性分析。
2015 年至 2016 年医疗保险受益人的 100%样本。
使用验证后的诊断代码识别痴呆症。在经历急性住院后入住 SNF 的受益人中，我们使用倾向评分匹配来平衡人口统计学、合并症、索引住院期间的特征、之前的住院和 SNF 利用情况以及 SNF 入院时的认知状态。
结果包括非计划性医院再入院、社区出院率和 SNF 入住期间的死亡率。多变量模型调整了医院和 SNF 的特征。
我们的样本包括 2418853 名从医院出院到 SNF 的医疗保险受益人；830524 人（34.3%）携带痴呆症诊断。总体而言，该样本中有 14.7%的人发生医院再入院，5.0%的人死亡，61.5%的人成功出院到社区。在倾向匹配队列中，患有痴呆症的受益人死亡率的比值比（OR）较低（0.87；95%置信区间[CI]0.86-0.89），医院再入院的比值比（OR）相似（0.99；95%置信区间[CI]0.98-1.00），社区出院的比值比（OR）降低（0.92；95%置信区间[CI]0.91-0.93）。然而，这些发现因 SNF 入院时认知障碍的严重程度而异：在无认知障碍的受益人中，痴呆症诊断的受益人不良结局的可能性更高。在严重认知障碍的受益人中，痴呆症诊断的受益人不良结局的可能性较低。
SNF 入院时的认知功能障碍是预测结果的一个更强指标，这表明需要针对认知障碍人群的 SNF 护理的获益和风险做出个体化决策。
