美国养老院康复期护理趋势：2001-2017 年。
Trends in Post-Acute Care in US Nursing Homes: 2001-2017.
机构信息
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
J Am Med Dir Assoc. 2021 Dec;22(12):2491-2495.e2. doi: 10.1016/j.jamda.2021.06.015.
OBJECTIVE
To describe recent trends in post-acute care provision within nursing homes, focusing specifically on nursing homes' degree of specialization in post-acute care.
DESIGN
Retrospective cohort study.
SETTING AND PARTICIPANTS
All US nursing homes between 2001 and 2017 and all fee-for-service Medicare admissions to nursing homes for post-acute care during that time.
METHODS
We measured post-acute care specialization as annual Medicare admissions per bed for each nursing home and examined changes in the distribution of specialization across nursing homes over the study period. We described the characteristics of nursing homes and the patients they serve based on degree of specialization.
RESULTS
The average number of Medicare admissions per bed increased from 1.2 in 2001 to 1.6 in 2017, a relative increase of 41%. This upward trend in the number of Medicare admissions per bed was largest among new nursing homes (those established after 2001), increasing 68% from 2001 to 2017. In contrast, nursing homes that eventually closed during the study period experienced no meaningful growth in the number of admissions per bed. Over time, the number of Medicare admissions per bed increased among highly specialized nursing homes. The number of Medicare admissions per bed grew by 66% at the 95th percentile and by 25% at the 99th percentile. Nursing homes delivering the most post-acute care were more likely to be for-profit or part of a chain, had higher staffing levels, and were less likely to admit patients who were Black, Hispanic, or dually enrolled in Medicare and Medicaid.
CONCLUSIONS AND IMPLICATIONS
Over the last 2 decades, post-acute care has become increasingly concentrated in a subset of nursing homes, which tend to be for-profit, part of a chain, and less likely to serve racial and ethnic minorities and persons on Medicaid. Although these nursing homes may benefit financially from higher Medicare payment, it may come at the expense of equitable access and patient care.
目的
描述养老院中康复后护理服务的最新趋势，特别关注养老院在康复后护理方面的专业化程度。
设计
回顾性队列研究。
地点和参与者
2001 年至 2017 年间，所有美国养老院，以及在此期间接受康复后护理的养老院的所有按服务收费的医疗保险入院患者。
方法
我们以养老院每床每年医疗保险入院人数来衡量康复后护理的专业化程度，并在研究期间观察专业化程度在养老院之间的分布变化。我们根据专业化程度描述了养老院和其服务患者的特征。
结果
养老院每床医疗保险入院人数从 2001 年的 1.2 人增加到 2017 年的 1.6 人，相对增加了 41%。这一每床医疗保险入院人数的上升趋势在新建养老院（2001 年后成立的养老院）中最大，从 2001 年到 2017 年增长了 68%。相比之下，在研究期间最终关闭的养老院，其每床入院人数并没有明显增长。随着时间的推移，高度专业化的养老院每床医疗保险入院人数增加。95%分位数的每床医疗保险入院人数增长了 66%，99%分位数的每床医疗保险入院人数增长了 25%。提供最多康复后护理的养老院更有可能是营利性或连锁机构，拥有更高的人员配置水平，并且更不可能接收非裔、西班牙裔或同时参加医疗保险和医疗补助的患者。
结论和意义
在过去的 20 年里，康复后护理越来越集中在一小部分养老院，这些养老院往往是营利性的、连锁的，并且不太可能为少数民族和医疗补助患者提供服务。尽管这些养老院可能从医疗保险的更高支付中受益，但这可能是以公平获得医疗和患者护理为代价的。
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