养老院居住期间日常活动改善方面的种族和民族差异。
Racial and ethnic differences in the improvement in daily activities during a nursing home stay.
机构信息
University of Texas Medical Branch School of Medicine, Galveston, Texas, USA.
Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas, USA.
出版信息
J Am Geriatr Soc. 2022 Apr;70(4):1244-1251. doi: 10.1111/jgs.17600. Epub 2021 Dec 9.
BACKGROUND
Improving independence in daily activities is an important outcome of postacute nursing home care. We investigated racial and ethnic differences in the improvement in activities of daily living (ADL) during a skilled nursing facility (SNF) stay among Medicare fee-for-service beneficiaries with a hip fracture, joint replacement, or stroke.
METHODS
This was a retrospective study of Medicare beneficiaries admitted to a SNF between 01/01/2013 and 9/30/2015. The final sample included 428,788 beneficiaries admitted to a SNF within 3 days of hospital discharge for a hip fracture (n = 118,790), joint replacement (n = 245,845), or stroke (n = 64,153). Data from residents' first and last Minimum Data Set were used to calculate ADL total scores for self-performance in dressing, personal hygiene, toileting, locomotion on the unit, transferring, bed mobility, and eating. Residents were dichotomized according to having had any improvement in the ADL total score. Multivariable logistic regression models that included a random intercept for the facility were used to estimate the adjusted odds ratios for any improvement in ADL function among black and Hispanic residents compared to white residents.
RESULTS
A total of 299,931 residents (69.9%) had any improvement in ADL function. Black residents (OR:0.94; 95% CI: 0.91-0.98) but not Hispanic residents (OR: 0.98; 95% CI: 0.94-1.03) had significantly lower odds to have any improvement in ADL function. Analyses stratified by the reason for prior hospitalization indicated that black residents discharged for hip fracture (OR: 0.87; 95% CI: 0.80-0.93) and stroke (OR: 0.87; 95% CI: 0.83-0.93), but not joint replacement (OR: 1.02; 95% CI: 0.97-1.06) had significantly lower odds for any ADL improvement compared to white residents.
CONCLUSIONS
Our findings are evidence for racial disparities in the improvement in ADL function during a SNF stay. Future research should investigate systemic factors that may contribute to disparities in the improvement in ADL function during a SNF stay.
背景
提高日常生活活动（ADL）的独立性是急性后期护理的一个重要结果。我们研究了在医疗保险按服务项目付费受益人中，患有髋部骨折、关节置换或中风的患者在熟练护理机构（SNF）住院期间 ADL 改善的种族和民族差异。
方法
这是一项对 2013 年 1 月 1 日至 2015 年 9 月 30 日期间入住 SNF 的 Medicare 受益人的回顾性研究。最终样本包括 428788 名在出院后 3 天内入住 SNF 的受益人，他们因髋部骨折（n=118790）、关节置换（n=245845）或中风（n=64153）而住院。使用居民首次和最后一次最低数据集的数据来计算自我表现的 ADL 总分，用于穿衣、个人卫生、如厕、在病房内移动、转移、床活动和进食。根据 ADL 总分是否有任何改善，将居民分为两类。使用包括设施随机截距的多变量逻辑回归模型来估计与白人居民相比，黑人居民（OR：0.94；95%CI：0.91-0.98）和西班牙裔居民（OR：0.98；95%CI：0.94-1.03）在 ADL 功能方面任何改善的调整比值比。
结果
共有 299931 名居民（69.9%）的 ADL 功能有任何改善。黑人居民（OR：0.94；95%CI：0.91-0.98）而不是西班牙裔居民（OR：0.98；95%CI：0.94-1.03）在 ADL 功能方面有显著更低的改善几率。按住院前的原因进行分层分析表明，髋部骨折（OR：0.87；95%CI：0.80-0.93）和中风（OR：0.87；95%CI：0.83-0.93）出院的黑人居民，但不是关节置换（OR：1.02；95%CI：0.97-1.06）与白人居民相比，ADL 任何改善的几率显著降低。
结论
我们的研究结果表明，在 SNF 住院期间，ADL 功能的改善存在种族差异。未来的研究应调查可能导致 SNF 住院期间 ADL 功能改善差异的系统性因素。
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