RAND Corporation, Boston, Massachusetts, USA.
Patient Reported Outcomes Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2022 Apr;70(4):991-1000. doi: 10.1111/jgs.17649. Epub 2022 Mar 2.
Each year millions of Medicare beneficiaries in the United States receive post-acute care (PAC) in skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), and home health agencies (HHA). We describe, overall and by PAC setting, the national population of facilities and patients, evaluate the representativeness of a national field test sample, and describe patient characteristics in the national field test sample.
We analyzed the 2016 Provider of Service file, 2016 patient assessment data reported by PAC providers to Centers for Medicare & Medicaid, and data collected from PAC providers participating in a national field test. National data included 27,234 PAC settings and 5,033,820 beneficiaries receiving PAC. The national field test sample consisted of 143 facilities across 14 markets with 25-30 patients sampled from each facility (n = 3669). We describe PAC facility and patient characteristics for both the national and field test sample.
Nationally, PAC facilities were more likely for-profit versus not for-profit, have an average nurse-to-bed ratio between 1:10 to 1:1 (lowest in SNFs) and be in metropolitan versus other areas. PAC patients were more likely to be white, female, and 75-89 years of age; heart failure as a primary medical condition tended to be more common than stroke or sepsis. There was limited variability across setting types. In the national field test, patients in LTCHs demonstrated a greater likelihood of cognitive impairment, positive depression screening, bowel and bladder appliance use, higher rates of medication drug classes taken, and use of therapeutic diets and IV medications.
The national field test facility and patient samples were fairly representative of the national population overall and across settings with a few exceptions. Moreover, differences according to PAC setting on patient characteristics in the national field test aligned with general differences in patient populations.
每年，美国数百万医疗保险受益人在熟练护理机构（SNF）、住院康复机构（IRF）、长期护理医院（LTCH）和家庭保健机构（HHA）接受康复后护理（PAC）。我们描述了整体和按 PAC 设置的全国设施和患者人群，评估了国家现场测试样本的代表性，并描述了国家现场测试样本中的患者特征。
我们分析了 2016 年服务提供者文件、PAC 提供者向医疗保险和医疗补助中心报告的 2016 年患者评估数据，以及参与国家现场测试的 PAC 提供者收集的数据。全国数据包括 27234 个 PAC 设置和 5033820 名接受 PAC 的受益人。国家现场测试样本由 14 个市场的 143 个设施组成，每个设施抽取 25-30 名患者（n=3669）。我们描述了全国和现场测试样本中 PAC 设施和患者的特征。
全国范围内，PAC 设施更可能是营利性的而不是非营利性的，护士与床位比例平均在 1:10 到 1:1（SNF 最低），并且位于大都市地区而不是其他地区。PAC 患者更可能是白人、女性和 75-89 岁；心力衰竭作为主要医疗状况比中风或败血症更常见。各种设置类型之间的差异有限。在全国现场测试中，LTCH 患者认知障碍、抑郁筛查阳性、肠道和膀胱器具使用、服用药物种类比例较高、使用治疗性饮食和静脉药物的可能性更大。
全国现场测试设施和患者样本总体上以及各设置类型之间都相当具有代表性，只有少数例外。此外，国家现场测试中患者特征按 PAC 设置的差异与患者人群的一般差异相符。
