Allman R M, Damiano A M, Strauss M J
Adv Wound Care. 1996 Mar-Apr;9(2):38-44.
In a prospective cohort study, we evaluated post-discharge health care utilization for patients 65 years of age or older whose activity was limited to bed or chair at the time of hospital admission. Post-discharge health care utilization was compared for those who did and those who did not develop a pressure ulcer during the hospital stay. Resource utilization was assessed using Medicare charges and payments reported for 1 year following the date of discharge. Pressure ulcer status during the index hospitalization was determined by study nurses. Sociodemographic data (age, gender, race, marital status) were recorded from the medical record. During the hospital stay, measures of severity of illness, occurrence of infections and other complications, service type (medical or surgical), ICU admission, and major and minor surgery were documented. At the time of discharge, the primary care nurse noted whether the patient was still confined to bed or chair and whether he or she was discharged to a nursing home. The study patients used substantial health care resources in the year following the index hospitalization, with mean Medicare charges and payments of $24,027 and $11,123, respectively. Eleven percent of the patients had developed pressure ulcers during the index hospitalization. These patients incurred Medicare payments during the 12-month post-discharge period that were, on average, $13 higher per day of follow-up than those of patients who had been at risk for, but did not develop, pressure ulcers during the index hospitalization (p = .02). Multivariate analyses suggested that activity limitation to bed or chair is an independent predictor of Medicare payments post-discharge. The in-hospital development of pressure ulcers is associated with higher daily Medicare payments in the year post-discharge, but this association does not remain statistically significant after adjusting for activity level at the time of hospital discharge.
在一项前瞻性队列研究中，我们评估了65岁及以上在入院时活动仅限于卧床或坐轮椅的患者出院后的医疗保健利用情况。比较了在住院期间发生和未发生压疮的患者出院后的医疗保健利用情况。利用出院日期后1年报告的医疗保险费用和支付情况评估资源利用情况。由研究护士确定指数住院期间的压疮状态。从病历中记录社会人口统计学数据（年龄、性别、种族、婚姻状况）。在住院期间，记录疾病严重程度、感染和其他并发症的发生情况、服务类型（内科或外科）、入住重症监护病房以及大手术和小手术情况。出院时，初级护理护士记录患者是否仍需卧床或坐轮椅以及是否出院至养老院。研究患者在指数住院后的一年中使用了大量医疗保健资源，医疗保险平均费用和支付分别为24,027美元和11,123美元。11%的患者在指数住院期间发生了压疮。这些患者在出院后12个月内的医疗保险支付，平均随访每天比在指数住院期间有压疮风险但未发生压疮的患者高出13美元（p = 0.02）。多变量分析表明，活动受限至卧床或坐轮椅是出院后医疗保险支付的独立预测因素。住院期间发生压疮与出院后一年中更高的每日医疗保险支付相关，但在调整出院时的活动水平后，这种关联不再具有统计学意义。
