Krishnan Shilpa, Hong Ickpyo, Couture Grace, Tzen Yi-Ting, Reistetter Timothy
Division of Physical Therapy, Department of Rehabilitation Science, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Health Care System, US Department of Veterans Affairs, Decatur, GA, USA.
Department of Occupational Therapy, Yonsei University, Wonju, Gangwon-do, South Korea.
J Am Med Dir Assoc. 2022 Oct;23(10):1718.e13-1718.e20. doi: 10.1016/j.jamda.2022.06.025. Epub 2022 Jul 31.
To describe pressure injury (PrI) prevalence, comorbidities, and rehabilitation utilization among older adults with stroke at skilled nursing facilities' (SNFs') admission assessment.
Retrospective cohort.
Older Medicare beneficiaries (>65 years old) with stroke admitted to SNFs.
We extracted data between 2013 and 2014 using the Master Beneficiary Summary, Medicare Provider Analysis and Review, and Minimum Data Set 3.0. PI data were assessed during admission assessment.
Of the 65,330 older adults poststroke admitted to SNFs, 11% had at least 1 PrI present on admission assessment. Individuals who were non-Hispanic Black, with a longer hospital stay, from lower socioeconomic status, with higher proportions of comorbidities (eg, underweight, urinary and bowel incontinence, diabetes, congestive heart failure, arrhythmias, and infections), and higher functional impairments were likely to present with a PrI at SNF admission assessment. Compared with individuals with superficial PrI, individuals with deep PrI were more likely to be young-old (<75 years), non-Hispanic Black, from lower socioeconomic status, present with a shorter hospital stay, an intensive care unit stay, with higher functional impairments, skin integrity issues, system failure, and infections. Compared to those without PrI or superficial PrI, individuals with any-stage PrI or deep PrI were more likely to be cotreated by physical and occupational therapist and less likely to receive individual therapy. Those with PrI poststroke had low documented turning and repositioning rates than those without PrI.
Identifying modifiable risk factors to prevent PrIs poststroke in SNFs will facilitate targeted preventative interventions and improve wound care efficacy and rehabilitation utilization for optimized patient outcomes. Identifying residents with a higher risk of PrI during acute care discharge and providing early preventive care during post-acute care would possibly decrease costs and improve outcome quality.
描述在专业护理机构（SNFs）入院评估时，中风老年患者的压力性损伤（PrI）患病率、合并症及康复利用情况。
回顾性队列研究。
入住SNFs的老年医疗保险受益人（>65岁）且患有中风。
我们在2013年至2014年期间，使用主要受益人摘要、医疗保险提供者分析与审查以及最小数据集3.0提取数据。压力性损伤数据在入院评估时进行评估。
在65330名入住SNFs的中风后老年患者中，11%在入院评估时有至少1处压力性损伤。非西班牙裔黑人、住院时间较长、社会经济地位较低、合并症比例较高（如体重过轻、大小便失禁、糖尿病、充血性心力衰竭、心律失常和感染）以及功能障碍程度较高的个体，在SNFs入院评估时更有可能出现压力性损伤。与浅表压力性损伤患者相比，深部压力性损伤患者更可能为年轻老年人（<75岁）、非西班牙裔黑人、社会经济地位较低、住院时间较短、入住过重症监护病房、功能障碍程度较高、存在皮肤完整性问题、系统衰竭和感染。与无压力性损伤或浅表压力性损伤的患者相比，任何阶段压力性损伤或深部压力性损伤的患者更有可能接受物理治疗师和职业治疗师的联合治疗，而接受个体治疗的可能性较小。中风后有压力性损伤的患者记录的翻身和重新定位率低于无压力性损伤的患者。
识别可改变的风险因素以预防SNFs中中风后的压力性损伤，将有助于进行有针对性的预防性干预，并提高伤口护理效果和康复利用率，以优化患者结局。在急性护理出院时识别压力性损伤风险较高的居民，并在急性后护理期间提供早期预防性护理，可能会降低成本并提高结局质量。
