University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
University of Houston-Clear Lake, 2700 Bay Area Blvd, Houston, TX, 77058, USA.
BMC Health Serv Res. 2023 Mar 1;23(1):204. doi: 10.1186/s12913-023-09184-2.
Geographic areas have been developed for many healthcare sectors including acute and primary care. These areas aid in understanding health care supply, use, and outcomes. However, little attention has been given to developing similar geographic tools for understanding rehabilitation in post-acute care. The purpose of this study was to develop and characterize post-acute care Rehabilitation Service Areas (RSAs) in the United States (US) that reflect rehabilitation use by Medicare beneficiaries.
A patient origin study was conducted to cluster beneficiary ZIP (Zone Improvement Plan) code tabulation areas (ZCTAs) with providers who service those areas using Ward's clustering method. We used US national Medicare claims data for 2013 to 2015 for beneficiaries discharged from an acute care hospital to an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long-term care hospital (LTCH), or home health agency (HHA). Medicare is a US health insurance program primarily for older adults. The study population included patient records across all diagnostic groups. We used IRF, SNF, LTCH and HHA services to create the RSAs. We used 2013 and 2014 data (n = 2,730,366) to develop the RSAs and 2015 data (n = 1,118,936) to evaluate stability. We described the RSAs by provider type availability, population, and traveling patterns among beneficiaries.
The method resulted in 1,711 discrete RSAs. 38.7% of these RSAs had IRFs, 16.1% had LTCHs, and 99.7% had SNFs. The number of RSAs varied across states; some had fewer than 10 while others had greater than 70. Overall, 21.9% of beneficiaries traveled from the RSA where they resided to another RSA for care.
Rehabilitation Service Areas are a new tool for the measurement and understanding of post-acute care utilization, resources, quality, and outcomes. These areas provide policy makers, researchers, and administrators with small-area boundaries to assess access, supply, demand, and understanding of financing to improve practice and policy for post-acute care in the US.
地理区域已被开发用于许多医疗保健领域，包括急症和初级保健。这些区域有助于了解医疗保健供应、使用和结果。然而，对于开发类似的地理工具来理解急性后康复护理，关注甚少。本研究的目的是在美国开发和描述反映医疗保险受益人康复使用的急性后康复服务区域 (RSA)。
采用患者来源研究，使用 Ward 聚类方法对服务于这些区域的提供者的受益人的邮政编码 (Zone Improvement Plan) 编码分区 (ZCTA) 进行聚类。我们使用 2013 年至 2015 年的美国全国医疗保险索赔数据，对从急症医院出院到住院康复机构 (IRF)、熟练护理机构 (SNF)、长期护理医院 (LTCH) 或家庭健康机构 (HHA) 的受益人进行分析。医疗保险是一项主要为老年人提供的美国健康保险计划。研究人群包括所有诊断组别的患者记录。我们使用 IRF、SNF、LTCH 和 HHA 服务来创建 RSA。我们使用 2013 年和 2014 年的数据（n=2,730,366）来开发 RSA，并使用 2015 年的数据（n=1,118,936）来评估稳定性。我们通过提供者类型的可用性、人群和受益人之间的流动模式来描述 RSA。
该方法产生了 1711 个离散的 RSA。其中 38.7%的 RSA 设有 IRF，16.1%设有 LTCH，99.7%设有 SNF。RSA 的数量因州而异；有些州少于 10 个，而有些州则多于 70 个。总体而言，21.9%的受益人从居住的 RSA 前往另一个 RSA 接受护理。
康复服务区域是一种新的工具，用于衡量和理解急性后康复护理的使用、资源、质量和结果。这些区域为政策制定者、研究人员和管理人员提供了小区域边界，以评估获得途径、供应、需求和对美国急性后康复护理融资的理解，以改善实践和政策。
