家庭病床与住院治疗

1研究背景家庭病床（Hospital at home）这一概念最早于1961年提出,通常是指在一段时间内,由医护专业人员为需住院治疗的患者提供主动的居家医疗服务。随着对急性住院床位需求的增加,美国、加拿大、荷兰、英国等许多国家都已开展家庭病床服务。但是,不同国家对家庭病床服务的界定各不相同。例如：英国的家庭病床服务主张由家庭护士向个人提供照护为主的服务;在北美地区,家庭病床主要提供静脉药物注射、输血等技术性服务。由于服务形式多种多样,系统评价根据患者来源,将家庭病床分为患者提前出院后居家治疗（包括老年患者和择期手术者）、居家治疗和临终照护等形式。     

Go Home,Sit Less: The Impact of Home Versus Hospital Rehabilitation Environment on Activity Levels of Stroke Survivors

Objective

To examine whether change in rehabilitation environment (hospital or home) and other factors influence time spent sitting upright and walking after stroke.

轻中度脑卒中患者的家庭运动治疗

脑卒中导致的残疾可能会持续一生,限制个人活动并且影响生活质量。脑卒中的发生率在近30年一直很稳定,但是死亡率和发作严重程度已经明显下降。脑卒中后活下来的绝大多数患者很少发生神经系统残疾,5年生存率大于50%。非严重性脑卒中后生存率的日益增加导致运动项目的需求增加,因此推荐家庭运动治疗作为轻中度脑卒中患者运动康复疗法,因为这种运动项目能加快恢复进程,提高功能状况,提高生活质量。     

The Operation of a Hospital Based Specialty Home Health Team: Activities and Associated Costs

Since 1972 a hospital based specialty home health team consisting of a Registered Nurse, a Registered Physical Therapist, and a Vocational Rehabilitation Counselor has been serving spinal cord injury patients hospitalized previously in a University affiliated Rehabilitation Center. This paper presents the preliminary findings resulting from a study examining the appropriateness, cost‐effectiveness, and efficiency of this unique rehabilitation facility service component.     

Hospital to Home Transition for Patients With Stroke Under Bundled Payments

Bundled payments are a promising alternative payment model for reducing costs and improving the coordination of postacute stroke care, yet there is limited evidence supporting the effectiveness of bundled payments for stroke. This may be due to the lack of effective strategies to address the complex needs of stroke survivors. In this article, we describe COMprehensive Post-Acute Stroke Services (COMPASS), a comprehensive transitional care intervention focused on discharge from the acute care setting to home. COMPASS may serve as a potential care redesign strategy under bundled payments for stroke, such as the Centers for Medicare & Medicaid Innovation Bundled Payment for Care Improvement Initiative. The COMPASS care model is aligned with the incentive structures and essential components of bundled payments in terms of care coordination, patient assessment, patient and family involvement, and continuity of care. Ongoing evaluation will inform the design of incorporating COMPASS-like transitional care interventions into a stroke bundle.