Barker W H, Zimmer J G, Hall W J, Ruff B C, Freundlich C B, Eggert G M
Department of Community and Preventive Medicine, University of Rochester Medical Center, NY 14642.
Am J Public Health. 1994 Oct;84(10):1615-20. doi: 10.2105/ajph.84.10.1615.
Hospitalization of nursing home residents is a growing, poorly defined problem. The purposes of this study were to define rates, patterns, costs, and outcomes of hospitalizations from nursing homes and to consider implications for reducing this problem as part of health care reform.
Communitywide nursing home utilization review and hospital discharge data were used to define retrospectively a cohort of 2120 patients newly admitted to nursing homes; these patients were followed for 2 years to identify all hospitalizations. Resident characteristics were analyzed for predictors of hospitalization. Charges and outcomes were compared with hospitalization of community-dwelling elders.
Hospitalization rates were strikingly higher for intermediate vs skilled levels of care (566 and 346 per 1000 resident years, respectively). Approximately 40% of all hospitalizations occurred within 3 months of admission. No strong predictors were identified. Length of stay, charges, and mortality rates were higher than for hospitalizations from the community.
Hospitalizations from nursing homes are not easily predicted but may in large part be prevented through health care reforms that integrate acute and longterm care.
疗养院居民住院是一个日益严重且定义不清的问题。本研究的目的是确定疗养院住院的发生率、模式、成本和结局，并探讨作为医疗改革一部分减少该问题的意义。
利用社区范围内的疗养院使用情况回顾和医院出院数据，对2120名新入住疗养院的患者进行回顾性队列研究；对这些患者随访2年以确定所有住院情况。分析居民特征以预测住院情况。将费用和结局与社区居住老年人的住院情况进行比较。
中级护理水平与熟练护理水平的住院率显著更高（分别为每1000居民年566次和346次）。所有住院情况中约40%发生在入院后3个月内。未发现有力的预测因素。住院时间、费用和死亡率高于社区住院情况。
疗养院住院情况不易预测，但通过整合急性护理和长期护理的医疗改革，很大程度上或许可以预防。
