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A Longitudinal Analysis of Functional Disability, Recovery, and Nursing Home Utilization After Hospitalization for Ambulatory Care Sensitive Conditions Among Community-Living Older Persons
Journal of Hospital Medicine ( IF 2.4 ) Pub Date : 2021-07-21 , DOI: 10.12788/jhm.3669
Cameron J Gettel 1, 2 , Arjun K Venkatesh 1, 3 , Linda S Leo-Summers 4 , Terrence E Murphy 4 , Evelyne A Gahbauer 4 , Ula Hwang 1, 5 , Thomas M Gill 4
Affiliation  

BACKGROUND/OBJECTIVE: Hospitalizations for ambulatory care sensitive conditions (ACSCs) are considered potentially preventable. With little known about the functional outcomes of older persons after ACSC-related hospitalizations, our objectives were to describe: (1) the 6-month course of postdischarge functional disability, (2) the cumulative monthly probability of functional recovery, and (3) the cumulative monthly probability of incident nursing home (NH) admission.

METHODS: The analytic sample included 251 ACSC-related hospitalizations from a cohort of 754 nondisabled, community-living persons aged 70 years and older who were interviewed monthly for up to 19 years. Patient-reported disability scores in basic, instrumental, and mobility activities ranged from 0 to 13. Functional recovery was defined as returning within 6 months of discharge to a total disability score less than or equal to that immediately preceding hospitalization.

RESULTS: The mean age was 85.1 years, and the mean disability score was 5.4 in the month prior to the ACSC-related hospitalization. After the ACSC-related hospitalization, total disability scores peaked at month 1 and improved modestly over the next 5 months, but remained greater than the pre-hospitalization score. Functional recovery was achieved by 70% of patients, and incident NH admission was experienced by 50% within 6 months after the 251 ACSC-related hospitalizations.

CONCLUSIONS: During the 6 months after an ACSC-related hospitalization, older persons exhibited total disability scores that were higher than those immediately preceding hospitalization, with 3 of 10 not achieving functional recovery and half experiencing incident NH admission. These findings provide evidence that older persons experience clinically meaningful adverse patient-reported outcomes after ACSC-related hospitalizations.



中文翻译:

社区生活老年人门诊护理敏感疾病住院后功能性残疾、康复和疗养院利用率的纵向分析

背景/目标:门诊护理敏感疾病 (ACSC) 住院被认为是可以预防的。由于对 ACSC 相关住院后老年人的功能结果知之甚少,我们的目标是描述:(1)出院后 6 个月的功能障碍病程,(2)功能恢复的每月累积概率,以及(3)事件疗养院 (NH) 入院的累积每月概率。

方法:分析样本包括 754 名 70 岁及以上的非残疾社区居民的 251 名 ACSC 相关住院患者,他们每月接受一次长达 19 年的访谈。患者报告的基本、工具和移动活动的残疾评分范围为 0 到 13。功能恢复被定义为在出院后 6 个月内恢复到总残疾评分小于或等于住院前的总残疾评分。

结果: ACSC 相关住院前一个月的平均年龄为 85.1 岁,平均残疾评分为 5.4。在与 ACSC 相关的住院治疗后,总残疾评分在第 1 个月达到峰值,并在接下来的 5 个月内略有改善,但仍高于住院前评分。70% 的患者实现了功能恢复,在 251 例 ACSC 相关住院后的 6 个月内,有 50% 的患者出现 NH 入院。

结论:在 ACSC 相关住院后的 6 个月内,老年人的总残疾评分高于住院前的患者,10 人中有 3 人没有实现功能恢复,一半人经历了 NH 入院。这些发现提供了证据,表明老年人在 ACSC 相关住院后经历了具有临床意义的不良患者报告结果。

更新日期:2021-07-21
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