Impact of Initial Stroke Rehabilitation Placement on Functional Recovery and Cost-effectiveness

初始中风康复安置对功能恢复和成本效益的影响

• 批准号: 10394334
• 负责人: Heather A Hayes
• 金额: $ 13.64万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10394334
• 关键词: Active Learning; Activities of Daily Living; Acute; Admission activity; Age; Algorithms; Beds; Caring; Client; Climate; Clinical; Cognitive; Comparative Effectiveness Research; Complex; Cost Effectiveness Analysis; Data; Decision Making; Exercise; Future; Goals; Guidelines; Health; Health Care Costs; Health Policy; Health Services Research; Healthcare; Home; Hospitals; Hour; Individual; Inpatients; Insurance; K-Series Research Career Programs; Knowledge; Length of Stay; Measures; Medicare; Outcome; Outcomes Research; Patient Care; Patient Recruitments; Patients; Persons; Physicians; Policy Research; Quality of life; Quality-Adjusted Life Years; Recovery; Recovery of Function; Rehabilitation therapy; Research; Research Activity; Research Personnel; Severities; Skilled Nursing Facilities; Stroke; Time; TimeLine; United States; Work; acute care; acute stroke; base; bed capacity; care costs; career; career development; comorbidity; cost; cost effective; cost effectiveness; disability; functional outcomes; functional status; health related quality of life; improved; indexing; inpatient service; markov model; meetings; mortality; post stroke; programs; readmission rates; rehabilitation science; rehabilitation service; rehabilitative care; sociodemographics; stroke event; stroke patient; stroke rehabilitation; stroke survivor; tool

PROJECT SUMMARY/ABSTRACT Stroke is a leading cause of long-term disability in the United States. A large portion of the cost of stroke care is rehabilitation. Providing optimal rehabilitation services aids in mitigating long-term disability for people after stroke. There are a lack of clinical guidelines and poor understanding of long-term outcomes after discharge from acute stroke care to an inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) for individuals post-stroke. Our current healthcare climate requires faster decision making and early discharge, and the results may be inappropriate discharge to an IRF or SNF, and thus not providing the patient with optimal outcomes. This project will assess client (e.g., stroke severity, co-morbidities, and sociodemographic) and non-client (e.g., bed availability and insurance) variables identified at the end of the acute hospital stay to determine which of these variables are associated with discharge to an IRF or SNF (Research Aim 1). This project will follow the clients to determine which of these client and non-client variables are associated with functional change—based on the AM-PAC Inpatient “6-Clicks” Basic Mobility, Daily Activity, and Applied Cognitive tools at short-term (after discharge from IRF or SNF) and long-term (6-months post-stroke; Research Aim 2). We will also determine cost- effective strategies of placement into an IRF, to a SNF, versus a tailored, based on the client and non-client variables identified in Aim 1 (Research Aim 3). We will use Markov modeling to predict related costs and quality- adjusted life years using the Health-Related Quality of Life in Stroke Patients. Understanding the outcomes within these similar post-acute care settings (IRF/SNF) for stroke is important in a rapidly evolving healthcare climate. This study is significant because it will provide data about what initial client and non-client variables predict long- term outcomes after discharge to an IRF or SNF and identify cost-effective strategies based on these variables. These research activities provide experiential learning in support of my career development objectives. These include increasing my knowledge and expertise in health services and policy research (Career Aim 1), comparative effectiveness and outcome research (Career Aim 2), and cost-effective analyses (Career Aim 3). This career development award will allow me to achieve my goal of becoming an independent stroke rehabilitation science investigator. The ultimate outcome will be improved health outcomes for individuals post- stroke, reduced disability, and reduced healthcare costs.

项目摘要/摘要 中风是美国长期残疾的主要原因。中风护理费用的很大一部分是 康复。提供最佳的康复服务有助于减轻人们的长期残疾 中风。缺乏临床准则，对出院后的长期结局的理解不足 从急性中风护理到住院康复设施（IRF）或熟练的护士设施（SNF） 冲程后。我们目前的医疗保健气候需要更快的决策和提早出院，结果 可能是不适当的IRF或SNF出院，因此不能为患者提供最佳的结果。这 项目将评估客户（例如，中风严重性，合并症和社会人口统计学）和非客户（例如床） 可用性和保险）变量在急性医院住宿结束时确定以确定其中哪些 变量与IRF或SNF的放电有关（研究目标1）。该项目将关注客户 确定这些客户端和非客户变量中的哪个与功能更改相关联 - 基于 AM-PAC住院的“ 6键”基本移动性，日常活动和应用的认知工具短期（之后 从IRF或SNF出院）和长期（中风后6个月；研究目的2）。我们还将确定成本 - 根据客户和非客户 AIM 1中确定的变量（研究目标3）。我们将使用马尔可夫建模来预测相关成本和质量 - 使用中风患者的健康相关生活质量调整了寿命。了解其中的结果 这些类似的急性后护理环境（IRF/SNF）在快速发展的医疗气候中很重要。 这项研究很重要，因为它将提供有关最初客户和非客户变量预测的数据 释放到IRF或SNF后的术语结果，并根据这些变量确定具有成本效益的策略。 这些研究活动提供了专家学习，以支持我的职业发展目标。这些 包括增加我在卫生服务和政策研究方面的知识和专业知识（职业目标1）， 比较有效性和结果研究（职业目标2）和具有成本效益的分析（职业目标3）。 这个职业发展奖将使我实现成为独立中风的目标 康复科学调查员。最终结果将是改善个人的健康状况 中风，降低残疾和降低医疗保健费用。