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公共资助医疗体系中肢体截肢后的出院去向。

Discharge Disposition After Limb Amputation in a Publicly Funded Health Care System.

机构信息

University of Saskatchewan, Saskatoon, SK, Canada.

出版信息

Inquiry. 2023 Jan-Dec;60:469580231176354. doi: 10.1177/00469580231176354.

Abstract

Understanding discharge disposition (DD) after limb amputation (LA) surgery allows health care providers and policy makers to adapt resources based on need. Studying independent prognostic factors for DD after LA in Canada eliminates the significant influence of payor source, as reported by researchers in the United States. We hypothesize disparities exist among DDs after LA in a publicly funded health care system. Retrospective review of Saskatchewan's linked administrative health data from 2006 to 2019 was used to identify independent socio-demographic factors, amputation levels, amputation predisposing factors (APF), and surgical specialty on 5 DD's: inpatient, continuing care, home with support services (H/W), home with no support services (H/WO), and those who died at the hospital after LA. We found age, amputation level, and APF play a significant role in determining discharge to all dispositions; gender was significantly associated with discharge to continuing care and H/WO; place of residence was associated with discharge to inpatient facilities, continuing care, and H/W; income was not associated with any DD other than H/W; surgical specialty was associated with discharge to all dispositions except death. The findings suggest that disparities in DD following LA exist even after eliminating the influence of payor source. Health care providers and policy makers should consider these findings in preparation for future needs.

摘要

了解肢体截肢 (LA) 手术后的出院去向 (DD),可以让医疗保健提供者和政策制定者根据需要调整资源。研究加拿大 LA 后 DD 的独立预后因素可以消除美国研究人员报告的支付来源的显著影响。我们假设在一个公费医疗保健系统中,LA 后的 DD 存在差异。对萨斯喀彻温省 2006 年至 2019 年的链接行政健康数据进行回顾性审查,以确定 5 种 DD(住院、持续护理、有支持服务的家庭 (H/W)、无支持服务的家庭 (H/WO) 和 LA 后在医院死亡)的独立社会人口统计学因素、截肢水平、截肢诱发因素 (APF) 和手术专业。我们发现年龄、截肢水平和 APF 对所有处置的出院去向起着重要作用;性别与持续护理和 H/WO 的出院显著相关;居住地与住院设施、持续护理和 H/W 的出院有关;收入与除 H/W 以外的任何 DD 均无关;手术专业与除死亡以外的所有 DD 有关。这些发现表明,即使消除了支付来源的影响,LA 后 DD 仍存在差异。医疗保健提供者和政策制定者应考虑这些发现,为未来的需求做好准备。

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