Felsenthal G, Cohen B S, Hilton E B, Panagos A V, Aiken B M
Arch Phys Med Rehabil. 1984 Jul;65(7):375-8.
Eighty-two patients admitted to a predominantly geriatric inpatient rehabilitation unit were followed throughout their stay in order to document their need for medical management. Their average age was 74.1 years and mean length of stay was 27.9 days. A total of 302 indications for medical intervention (3.7/patient) were found. In addition there were 2.8 medication changes/patient found when comparing admission to discharge medications, and 0.7 medications/patient prescribed for intercurrent illnesses. Actual documented loss of planned therapy time was found 21 times, involving 19 patients but exceeded 1 day in only six patients. Fifty-eight patients were ultimately discharged home, 14 were discharged to nursing homes (7 for social reasons), and 10 were transferred to an acute general hospital. Adverse drug reactions occurred in 27% of the patients and incidence rate paralleled the number of medications prescribed for the patient. This study indicates that the physiatrist on an inpatient rehabilitation unit must function as team manager or program director, and as the patient's primary physician. By managing medical problems effectively, the physician limits the loss of therapy time, thus shortening the length of stay and enabling the patient to continue to participate in his rehabilitation program.
对入住以老年患者为主的住院康复科的82名患者在其住院期间进行了全程跟踪，以记录他们对医疗管理的需求。他们的平均年龄为74.1岁，平均住院时间为27.9天。共发现302次医疗干预指征（平均每名患者3.7次）。此外，对比入院时和出院时的用药情况，每名患者平均有2.8次用药调整，因并发疾病每名患者平均有0.7种用药。实际记录的计划治疗时间损失共出现21次，涉及19名患者，但只有6名患者的治疗时间损失超过1天。最终，58名患者出院回家，14名患者出院后入住养老院（7名因社会原因），10名患者转至综合急症医院。27%的患者发生了药物不良反应，其发生率与患者的用药数量成正比。本研究表明，住院康复科的物理治疗师必须担当团队管理者或项目负责人，以及患者的主治医生。通过有效处理医疗问题，医生可减少治疗时间的损失，从而缩短住院时间，并使患者能够继续参与其康复计划。
