Center for Health Policy, Columbia University School of Nursing, New York, NY, USA.
Center for Health Policy, Columbia University School of Nursing, New York, NY, USA.
J Am Med Dir Assoc. 2024 Sep;25(9):105149. doi: 10.1016/j.jamda.2024.105149. Epub 2024 Jul 14.
To review evidence on post-acute care (PAC) use and disparities related to race and ethnicity and rurality in the United States over the past 2 decades among individuals who underwent major joint replacement (MJR).
Systematic review.
We included studies that examined US PAC trends and racial and ethnic and/or urban vs rural differences among individuals who are aged ≥18 years with hospitalization after MJR.
We searched large academic databases (PubMed, CINAHL, Embase, Web of Science, and Scopus) for peer-reviewed, English language articles from January 1, 2000, and January 26, 2022.
Seventeen studies were reviewed. Studies (n = 16) consistently demonstrated that discharges post-MJR to skilled nursing facilities (SNFs) or nursing homes (NHs) decreased over time, whereas evidence on discharges to inpatient rehab facilities (IRFs), home health care (HHC), and home without HHC services were mixed. Most studies (n = 12) found that racial and ethnic minority individuals, especially Black individuals, were more frequently discharged to PAC institutions than white individuals. Demographic factors (ie, age, sex, comorbidities) and marital status were not only independently associated with discharges to institutional PAC, but also among racial and ethnic minority individuals. Only one study found urban-rural differences in PAC use, indicating that urban-dwelling individuals were more often discharged to both SNF/NH and HHC than their rural counterparts.
Despite declines in institutional PAC use post-MJR over time, racial and minority individuals continue to experience higher rates of institutional PAC discharges compared with white individuals. To address these disparities, policymakers should consider measures that target multimorbidity and the lack of social and structural support among socially vulnerable individuals. Policymakers should also consider initiatives that address the economic and structural barriers experienced in rural areas by expanding access to telehealth and through improved care coordination.
回顾过去 20 年来，在美国接受过主要关节置换术（MJR）的人群中，与种族、民族和农村地区相关的 PAC 使用和差异的证据。
系统评价。
我们纳入了研究，这些研究检查了美国 PAC 趋势以及年龄≥18 岁的人群中，在 MJR 后住院的个体的种族、民族和/或城乡差异。
我们从 2000 年 1 月 1 日和 2022 年 1 月 26 日，在大型学术数据库（PubMed、CINAHL、Embase、Web of Science 和 Scopus）中搜索同行评审的英文文章。
共审查了 17 项研究。研究（n=16）一致表明，MJR 后出院到熟练护理机构（SNFs）或疗养院（NHs）的人数随着时间的推移而减少，而关于住院康复设施（IRFs）、家庭保健（HHC）和无 HHC 服务的家庭的出院情况则好坏参半。大多数研究（n=12）发现，与白人相比，少数族裔，尤其是黑人，更常被送往 PAC 机构。人口统计学因素（即年龄、性别、合并症）和婚姻状况不仅与机构 PAC 的出院独立相关，而且与少数族裔也有关。只有一项研究发现 PAC 使用的城乡差异，表明城市居民比农村居民更常被送往 SNF/NH 和 HHC。
尽管随着时间的推移，MJR 后机构 PAC 的使用有所下降，但少数族裔和少数民族的个体继续经历更高的机构 PAC 出院率，高于白人。为了解决这些差异，政策制定者应考虑采取措施，针对多病和社会弱势群体缺乏社会和结构支持的问题。政策制定者还应考虑通过扩大远程医疗服务的机会以及通过改善护理协调来解决农村地区面临的经济和结构性障碍的举措。
