Geriatrics & Extended Care Data Analyses Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; RAND Corporation, Santa Monica, CA, USA.
J Am Med Dir Assoc. 2021 Dec;22(12):2425-2431.e7. doi: 10.1016/j.jamda.2021.10.007. Epub 2021 Nov 2.
The quality of care provided by the US Department of Veterans Affairs (VA) is increasingly being compared to community providers. The objective of this study was to compare the VA Community Living Centers (CLCs) to nursing homes in the community (NHs) in terms of characteristics of their post-acute populations and performance on 3 claims-based ("short-stay") quality measures.
Observational, cross-sectional.
CLC and NH residents admitted from hospitals during July 2015-June 2016.
CLC residents were compared with 3 NH populations: males, Veterans, and all NH residents. CLC and NH performance was compared on risk-adjusted claims-based measures: unplanned rehospitalizations and emergency department visits within 30 days of CLC or NH admission and successful discharge to the community within 100 days of NH admission.
Veterans admitted from hospitals to CLCs (n = 23,839 Veterans/135 CLCs) were less physically impaired, less likely to have anxiety, congestive heart failure, hypertension, and dementia than Veterans (n = 241,177/14,818 NHs), males (n = 661,872/15,280 NHs), and all residents (n = 1,674,578/15,395 NHs) admitted to NHs from hospitals. Emergency department and successful discharge risk-adjusted rates of CLCs were statistically significantly better than those of NHs [mean (standard deviation): 8.3% (4.6%) and 67.7% (11.5%) in CLCs vs 11.9% (5.3%) and 57.0% (10.5%) in NHs, respectively]. CLCs had slightly worse rehospitalization rates [22.5% (6.2%) in CLCs vs 21.1% (5.9%) in NHs], but lower combined emergency department and rehospitalization rates [30.8% (0.8%) in CLCs vs 33.0% (0.7%) in NHs].
CLCs and NHs serve different post-acute care populations. Using the same risk-adjusted NH quality metrics, CLCs provided better post-acute care than community NHs.
美国退伍军人事务部（VA）提供的护理质量越来越多地与社区提供者进行比较。本研究的目的是将 VA 社区生活中心（CLC）与社区中的疗养院（NH）在其急性后人群的特征以及 3 项基于索赔的（“短期住院”）质量措施方面的表现进行比较。
观察性，横断面研究。
2015 年 7 月至 2016 年 6 月期间从医院入院的 CLC 和 NH 居民。
将 CLC 居民与 3 种 NH 人群进行比较：男性、退伍军人和所有 NH 居民。将 CLC 和 NH 的表现与风险调整后的基于索赔的措施进行比较：CLC 或 NH 入院后 30 天内计划外再住院和急诊就诊，以及 NH 入院后 100 天内成功出院到社区。
从医院转入 CLC 的退伍军人（n=23839 名退伍军人/135 个 CLC）的身体损伤程度低于退伍军人（n=241177/14818 NHs）、男性（n=661872/15280 NHs）和所有居民（n=1674578/15395 NHs），焦虑、充血性心力衰竭、高血压和痴呆的可能性较小。CLC 的急诊和成功出院风险调整率明显优于 NHs[平均值（标准差）：CLC 为 8.3%（4.6%）和 67.7%（11.5%），NHs 为 11.9%（5.3%）和 57.0%（10.5%）]。CLC 的再入院率略高[22.5%（6.2%）在 CLC 中 vs 21.1%（5.9%）在 NH 中]，但联合急诊和再入院率较低[30.8%（0.8%）在 CLC 中 vs 33.0%（0.7%）在 NH 中]。
CLC 和 NH 为不同的急性后护理人群提供服务。使用相同的风险调整后的 NH 质量指标，CLC 提供的急性后护理优于社区 NH。
