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《Journal of the American Medical Directors Association》2022,23(11):1883.e1-1883.e8
ObjectivesGeriatric inpatient rehabilitation aims to restore function, marked by physical performance, to enable patients to return and remain home after hospitalization. However, after discharge some patients are soon readmitted, institutionalized, or may die. Whether changes in physical performance during geriatric rehabilitation are associated with these short-term adverse outcomes is unknown. This study aimed to determine the association of changes in physical performance during geriatric inpatient rehabilitation with short-term adverse outcomes.DesignObservational longitudinal study.Setting and ParticipantsGeriatric rehabilitation inpatients of the REStORing health of acutely unwell adulTs (RESORT) cohort study of the Royal Melbourne Hospital (Melbourne, Australia) were included.MethodsThe change from admission to discharge in the Short Physical Performance Battery (SPPB) score, balance, gait speed (GS), chair stand test (CST), and hand grip strength (HGS) were calculated and analyzed using logistic regression analysis with readmission, incidence of institutionalization, and mortality, and ≥1 adverse outcome within 3 months postdischarge.ResultsOf 693 inpatients, 11 died during hospitalization and 572 patients (mean age 82.6 ± 7.6 years, 57.9% female) had available physical performance data. Within 3 months postdischarge, 47.3% of patients had ≥1 adverse outcome: readmission was 20.8%, institutionalization was 26.6%, and mortality was 7.9%. Improved SPPB score, balance, GS, CST, and HGS were associated with lower odds of institutionalization and mortality. Improved GS was additionally associated with lower odds of readmission [odds ratio (OR) 0.35, 95% CI 0.16-0.79]. CST score had the largest effect, with a 1-point increase associating with 40% lower odds of being institutionalized (OR 0.60, 95% CI 0.42-0.86), 52% lower odds of mortality (OR 0.48, 95% CI 0.29-0.81), and a 24% lower odds of ≥1 adverse outcome (OR 0.76, 95% CI 0.59-0.97).Conclusions and ImplicationsImprovement in physical performance was associated with lower odds of short-term institutionalization and mortality indicating the prognostic value of physical performance improvement during geriatric inpatient rehabilitation. 相似文献
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《Journal of the American Medical Directors Association》2022,23(11):1845-1853.e5
ObjectiveThe Improving Medicare Post-Acute Care Transformation Act of 2014 mandates using standardized patient functional data across post-acute settings. This study characterized similarities and differences in clinician-observed scores of self-care and transfer items for the standardized section GG functional domain and the functional independent measure (FIM) at inpatient rehabilitation facilities.DesignWe conducted secondary analyses of 2017 Uniform Data System for Medical Rehabilitation national data. Patients were assessed by clinicians on both section GG and FIM at admission and discharge. We identified 7 self-care items and 6 transfer items in section GG conceptually equivalent with FIM. Clinician-assessed scores for each pair of items were examined using score distributions, Bland-Altman plot, correlation (Pearson coefficients), and agreement (kappa and weighted kappa) analyses.Setting and ParticipantsIn all, 408,491 patients were admitted to Uniform Data System for Medical Rehabilitation-affiliated inpatient rehabilitation facilities with one of the following impairments: stroke, brain dysfunction, neurologic condition, orthopedic disorders, and debility.MeasuresSection GG and FIM.ResultsPatients were scored as more functionally independent in section GG compared with FIM, but change score distributions and score orders within impairment groups were similar. Total scores in section GG had strong positive correlations (self-care: r = 0.87 and 0.95; transfer: r = 0.82 and 0.90 at admission and discharge, respectively) with total FIM scores. Weak to moderate ranking agreements with total FIM scores were observed (self-care: kappa = 0.49 and 0.60; transfers: kappa = 0.43 and 0.52 at admission and discharge, respectively). Lower agreements were observed for less able patients at admission and for higher ability patients of their change scores.Conclusions and ImplicationsOverall, response patterns were similar in section GG and FIM across impairments. However, variations exist in score distributions and ranking agreement. Future research should examine the use of GG codes to maintain effective care, outcomes, and unbiased reimbursement across post-acute settings. 相似文献
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Melissa J. Bloomer Mari Botti Fiona Runacres Peter Poon Jakqui Barnfield Alison M. Hutchinson 《Collegian (Royal College of Nursing, Australia)》2019,26(1):22-27
Background
With an ageing population and chronic illness the leading cause of death, challenges exist in meeting the healthcare needs of older people. For older people, care may be provided in subacute care services where, although the focus is on rehabilitation and optimisation of functioning, many older people will die.Aim
To investigate end-of-life care provision for older people in subacute care.Methods
A retrospective clinical chart audit of all subacute inpatient deaths in one year.Results
54 inpatients died in subacute care and almost all had been transferred from an acute care setting. The mean age was 83 (SD = 9), patients had multiple diagnoses and were admitted for assessment or to establish a safe discharge destination. None were identified as ‘terminal’ on admission and none had an Advance Care Plan to guide care preferences. Prior to death, more than half (57.4%) received terminal care compliant with the Promoting Improved Care of the Dying (PICD) guideline. 53.7% were referred for specialist palliative care review, and despite a mean wait time of 0.6 days (SD = 0.8), 11.1% of patients died before specialist palliative care review. Documentation of communication with patients/family of the likelihood of death occurred in two key sequential time points; the first was information-related and the second decision-related. When these time points occurred impacted end-of-life care provision. Ambiguity in language used to communicate patient deterioration and dying with clinicians and family, impacted understanding and provision of end-of-life care.Conclusions
Education is needed to aid clinicians in subacute care to identify patient deterioration and dying and communicate the likelihood of death to the multidisciplinary team and with patients and families. Nursing and allied health clinicians are well placed to have greater involvement in communicating patient deterioration and likely death. 相似文献8.
目的探讨金水宝胶囊联合左甲状腺素钠片治疗桥本甲状腺炎的临床疗效。方法选取2015年5月—2017年5月上海市闵行区中心医院收治的70例桥本甲状腺炎患者为研究对象,所有患者按照随机数字表法分为对照组和治疗组,每组各35例。对照组口服左甲状腺素钠片,起始剂量为25~50μg,1次/d,根据甲状腺功能情况调整用量,维持剂量为25~150μg,1次/d。治疗组在对照组基础上口服金水宝胶囊,3粒/次,3次/d。两组患者均治疗24周。观察两组的临床疗效,比较两组的甲状腺激素、抗体水平和血清炎症因子水平。结果治疗后,对照组和治疗组的总有效率分别为71.43%、85.71%,两组比较差异具有统计学意义(P0.05)。治疗后,两组游离三碘状腺素(FT3)、游离甲状腺素(FT4)水平均显著升高,促甲状腺素(TSH)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);并且治疗后治疗组FT3、FT4水平均显著高于对照组,TSH、TPOAb、TGAb水平均显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)水平均明显降低,白细胞介素-10(IL-10)水平均明显升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组CRP、TNF-α、IL-2水平均明显低于对照组,IL-10水平明显高于对照组,两组比较差异具有统计学意义(P0.05)。结论金水宝胶囊联合左甲状腺素钠片治疗桥本甲状腺炎具有较好的临床疗效,可改善患者甲状腺功能,调节血清炎症因子水平,安全性较好,具有一定临床应用价值。 相似文献
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