目标:出院到熟练护理机构(SNFs)的患者的身体和认知状况,住院康复设施(IRF),以及全关节置换术(TJA)后与家庭保健机构(HHA)的家庭尚未评估。这项研究的目的是检查出院的医疗保险受益人的身体和认知功能趋势,HHA,以及2013年至2018年TJA之后的IRF。
方法:使用Medicare注册的观察性研究,索赔,和2013-2018年的评估数据。
方法:1,278,939名医疗保险受益人向SNF出院,HHA,或2013年至2018年TJA后急性护理的IRF。
方法:Medicare数据用于检查感兴趣的终点之间的关联[出院目的地(SNF,HHA,或IRF)以及每种设置中患者的身体(使用日常生活活动进行测量)和认知(使用一系列特定设置的指标进行测量)状态]以及TJA年份(2013-2018)通过估计多变量模型控制患者和医院级别的协变量。
结果:对1,278,939个TJAs的多变量分析显示,SNF放电减少[44.15%(2013年)-21.57%(2018年),P<.001],HHA增加(46.72%-72.47%,P<.001),和IRF下降(9.13%-5.69%,P<.001)。对于SNF,平均身体机能得分[14.61(2013)-14.23(2018),P<.001]和认知障碍(13.25%-12.33%,P=0.01)减少,表明依赖性较小。身体功能评分(3.09-3.94,P<.001)和认知障碍(13.95%-16.52%,P<.001)HHA患者增加,表明更大的依赖性。对于IRF,运动功能独立性测量值降低(38.81-37.78,P<.001),认知依赖性增加(39.08%-46.36%,P<.001),表明更大的依赖性。
结论:从2013年到2018年,越来越多的患者出院到HHA。尽管SNF患者随着时间的推移依赖性较小,HHA和IRF患者的身体和认知依赖性更强。每种设置都可能受益于政策和财政支持,帮助他们管理需要服务的患者数量和临床强度的变化。
OBJECTIVE: Physical and cognitive conditions of patients discharged to skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and home with home health agencies (HHAs) following total joint arthroplasty (TJA) have not been evaluated. The purpose of this study is to examine the physical and cognitive function trends of Medicare beneficiaries discharged to SNFs, HHAs, and IRFs following TJA from 2013 to 2018.
METHODS: Observational study using Medicare enrollment, claims, and assessment data from 2013-2018.
METHODS: 1,278,939 Medicare beneficiaries discharged to SNFs, HHAs, or IRFs for post-acute care following TJA from 2013 to 2018.
METHODS: Medicare data were used to examine the association between the endpoints of interest [discharge destination (SNF, HHA, or IRF) and the physical (measured using activities of daily living) and cognitive (measured using a range of setting-specific metrics) status of patients in each setting] and the year of TJA (2013-2018) by estimating multivariable models that controlled for patient- and hospital-level covariates.
RESULTS: Multivariable analysis of 1,278,939 TJAs revealed that SNF discharge decreased [44.15% (2013)-21.57% (2018), P < .001], HHA increased (46.72%-72.47%, P < .001), and IRF decreased (9.13%-5.69%, P < .001). For SNF, the mean physical function scores [14.61 (2013)-14.23 (2018), P < .001] and cognitive impairment (13.25%-12.33%, P = .01) decreased, indicating less dependence. Physical function scores (3.09-3.94, P < .001) and cognitive impairment (13.95%-16.52%, P < .001) increased for HHA patients, indicating greater dependence. For IRF, motor functional independence measure decreased (38.81-37.78, P < .001) and cognitive dependence increased (39.08%-46.36%, P < .001), indicating greater dependence.
CONCLUSIONS: From 2013 to 2018, patients were increasingly discharged to HHA. Although SNF patients were less dependent over time, HHA and IRF patients were physically and cognitively more dependent. Each setting is likely to benefit from policy and fiscal supports that help them manage changes in the volume and clinical intensity of patients requiring their services.