Herbold Janet, Elmohsen Ebrahim, Gutierrez Gino, Helgesen Michael, Babyar Suzanne
Post Acute Services, Burke Rehabilitation Hospital, White Plains, NY.
Department of Physical Therapy, Hunter College, The City University of New York, New York, NY.
Arch Rehabil Res Clin Transl. 2023 Aug 15;5(4):100292. doi: 10.1016/j.arrct.2023.100292. eCollection 2023 Dec.
OBJECTIVE: To determine the ability of Section GG of the Inpatient Rehabilitation Facility - Patient Assessment Inventory (Section GG)'s quantification of mobility and self-care to predict discharge destination for persons with stroke after inpatient rehabilitation. DESIGN: Retrospective, observational cohort study. SETTING: 150-bed inpatient rehabilitation facility within a metropolitan health system. PARTICIPANTS: Consecutive sample of adults and older adults with stroke admitted for inpatient rehabilitation from January 2020 to June 2021 (N=1051). Subjects were excluded for discharge to acute care or hospice or if they had COVID-19. INTERVENTION: None. MAIN OUTCOME MEASURES: Section GG self-care and mobility scores used in reimbursement formulation by Centers for Medicare and Medicaid at admission to inpatient rehabilitation; age; sex; prior living situation; discharge setting. Logistic regression examined binary comparisons of discharge destinations. Receiver operating characteristic (ROC) curves determined cut-off admission Section GG scores for binary comparisons. RESULTS: Logistic regression demonstrated that presence of a caregiver in the home was consistently the strongest predictor (<.001) and admission Section GG scores were significant secondary factors in determining the discharge destination. An admission Section GG cut-off score of 33.5 determined home with homecare vs skilled nursing facility and a cut-off of 36.5 determined discharge to home with outpatient care vs skilled nursing facility. CONCLUSION: Clinicians responsible for discharge decisions for patients with stroke after inpatient rehabilitation might start by determining the presence of a caregiver in the home and then use Section GG cut-off scores to guide decisions about home (with or without homecare) vs SNF destinations. Such guidance is not advised for the home with outpatient services vs home with homecare decision; clinical judgment is needed to determine the best discharge plan because this ROC had a less robust area under the curve. Sex and race/ethnicity were not determining factors for binary choices of discharge destinations.
目的:确定住院康复机构患者评估量表(GG部分)对移动性和自我护理的量化能力,以预测中风患者住院康复后的出院去向。 设计:回顾性观察队列研究。 地点:大都市卫生系统内拥有150张床位的住院康复机构。 参与者:2020年1月至2021年6月因中风入院接受住院康复的成人及老年人连续样本(N = 1051)。排除出院至急性护理机构或临终关怀机构的患者,或患有COVID-19的患者。 干预措施:无。 主要观察指标:住院康复入院时医疗保险和医疗补助服务中心用于报销制定的GG部分自我护理和移动性评分;年龄;性别;先前的生活状况;出院地点。逻辑回归分析了出院去向的二元比较。受试者工作特征(ROC)曲线确定了二元比较的入院GG部分评分临界值。 结果:逻辑回归表明,家中有护理人员一直是最强的预测因素(<.001),入院GG部分评分是决定出院去向的重要次要因素。入院GG部分临界评分为33.5时,可确定回家接受家庭护理与入住专业护理机构;临界评分为36.5时,可确定出院回家接受门诊护理与入住专业护理机构。 结论:负责中风患者住院康复后出院决策的临床医生可以先确定家中是否有护理人员,然后使用GG部分临界评分来指导关于回家(有无家庭护理)与入住专业护理机构的决策。对于回家接受门诊服务与回家接受家庭护理的决策,不建议采用此类指导;需要临床判断来确定最佳出院计划,因为此ROC曲线下面积的稳健性较差。性别和种族/族裔不是出院去向二元选择的决定因素。
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