VA Post-Stroke Rehabilitation: Comparing Institutional Long-Term Care Settings

VA 中风后康复：比较机构长期护理设置

• 批准号: 8483019
• 负责人: Huanguang Jia
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8483019
• 关键词: Acute; Address; Admission activity; Age; Antidepressive Agents; Articular Range of Motion; Attitude; Bed Occupancy; Beds; Behavior Disorders; Braces-Orthopedic appliances; Caring; Case Mixes; Categories; Characteristics; Chronic; Communication; Communities; Comorbidity; Contracts; Data; Data Set; Databases; Decision Making; Deglutition; Diagnosis; Discipline of Nursing; Eating; Education; Enabling Factors; Ethnic Origin; Funding; Future; Gender; Goals; Grooming; Healthcare; Hospitals; Intervention; Length of Stay; Link; Logistic Regressions; Logit Models; Long-Term Care; Marital Status; Medical; Mental Depression; Meta-Analysis; Methods; Modeling; Moods; Nursing Homes; Occupational Therapy; Outcome; Outcome Measure; Ownership; Patients; Persons; Pharmaceutical Preparations; Physical Function; Physical therapy; Policy Maker; Predisposing Factor; Process; Quality of Care; Race; Recovery; Rehabilitation therapy; Research; Respiratory Therapy; Retrospective Studies; Risk; Rural; Services; Source; Speech Therapy; Speed; Splint Device; Sterile coverings; Stroke; Structure; Variant; Veterans; Walking; base; cognitive function; community living; comparative; cost; disability; evidence base; functional disability; health care service utilization; meetings; mortality; post stroke; programs; psychologic; rehabilitation service; residence; response; statistics; stroke rehabilitation

DESCRIPTION (provided by applicant): Background: Each year, approximately 3,900 and 14,100 Veterans reside in VA community living centers (CLCs) and VA per diem contracted community nursing homes (CNHs) for post-stroke care, respectively. A growing body of evidence shows that when effective rehabilitation interventions are continued post-stroke, they can speed patient recovery processes and minimize patient functional disabilities and deficits. Although VA has funded studies examining the structure, process and outcomes of rehabilitation services received by Veterans in CLCs and/or CNHs, these studies have focused on CLCs alone or on CLCs and CNHs within a single state. To better understand the quality of care received by Veteran residents of different types of nursing facilities, further research is needed on the adjusted quality outcomes and geographical variations among Veterans with the same medical condition who reside in CLCs or CNHs. Objectives: The goals of this study are to examine institutional long-term rehabilitation care and to assess the quality and geographical variations of rehabilitation services received by VA stroke residents in CLCs versus VA stroke residents in CNHs. The three specific aims are: (1) to compare the differences in nursing home and VA stroke resident characteristics between CLCs and CNHs nationally and by Veterans Integrated Service Network (VISN); (2) to examine the differences in rehabilitation care, restorative care, and mood-behavioral disorder care received by the residents between CLCs and CNHs nationally and by VISN; and (3) to evaluate the differences of VA stroke residents in physical function, cognitive function, depression status, 12-month mortality and stroke rehospitalization between CLCs and CNHs nationally and by VISN. The long-term objectives are to systematically examine multiple-source long-term rehabilitation care; determine geographical variations in rehabilitation care; examine the comparative costs of rehabilitation care; and develop an integrated long-term rehabilitation care and outcome database for VA stroke patients. Methods: This retrospective study includes all VA residents who were diagnosed with stroke and newly admitted to CLCs or CNHs from January 1, 2006 to December 31, 2009, regardless of their race/ethnicity, gender, and age. CLC and CNH Minimum Data Sets (MDS) will be linked with different VA datasets to define residents' stroke diagnoses and obtain the data needed for the study. For Objective 1, descriptive statistics will be obtained on all variables and comparisons of facility and resident characteristics will be conducted between CLCs and CNHs nationally and by VISN. For Objective 2, Poisson regression or two-part model of health services utilization will be used to analyze rehabilitation and restorative services; cumulative logit model will be applied to assess the ordered response of mood-behavioral disorder care. For Objective 3, we will assess the differences between CLCs and CNHs in the ADL function, cognitive function and depression change from admission to 3-, 6- and 9-month and combine the evidence to assess the overall difference using meta-analysis method. Logistic regression for mortality and Poisson regression for the number of stroke rehospitalizations will be fitted. Objective 2 and 3 analyses will be case-mix risk-adjusted; national and VISN comparisons will be made between the residents in CLCs and CNHs. Significance: Quality and geographical variations in services for Veterans are of the highest importance since stroke is prevalent among VA patients. CLCs and CNHs are two major sources of long-term care for Veterans, and VA continues to expand its long-term programs to meet the increasing needs of Veterans with chronic disabilities. The study addresses two of HSR&D's funding priority categories: long-term care and healthcare access. Findings from the study are important for VA policy makers, clinicians, and Veterans, and will enable them make future decisions regarding the appropriate placement of Veterans in rehabilitation facilities for post- stroke care. The study will provide evidence-based information about the quality and geographical variations in post-stroke, institutional long-term rehabilitatio care among Veteran residents in CLCs and CNHs.

描述（由申请人提供）： 背景：每年，大约有 3,900 名和 14,100 名退伍军人分别居住在 VA 社区生活中心 (CLC) 和 VA 每日承包社区疗养院 (CNH) 中接受中风后护理。 越来越多的证据表明，如果中风后继续进行有效的康复干预，可以加快患者的康复过程，并最大限度地减少患者的功能障碍和缺陷。 尽管退伍军人事务部资助了研究，检查退伍军人在 CLC 和/或 CNH 中接受的康复服务的结构、过程和结果，但这些研究仅关注 CLC 或单个州内的 CLC 和 CNH。 为了更好地了解不同类型护理机构的退伍军人居民接受的护理质量，需要进一步研究居住在 CLC 或 CNH 的具有相同医疗状况的退伍军人之间调整后的质量结果和地理差异。 目的：本研究的目的是检查机构长期康复护理，并评估 CLC 中的 VA 中风居民与 CNH 中的 VA 中风居民所接受的康复服务的质量和地域差异。 这三个具体目标是：(1) 比较全国 CLC 和 CNH 以及退伍军人综合服务网络 (VISN) 的疗养院和 VA 中风居民特征的差异； (2) 检查全国 CLC 和 CNH 以及 VISN 居民接受的康复护理、恢复性护理和情绪行为障碍护理的差异； (3)评估VA卒中居民在身体功能、认知功能、抑郁状态、 全国 CLC 和 CNH 之间以及 VISN 的 12 个月死亡率和中风再住院情况。 长期目标是系统地研究多源长期康复护理；确定康复护理的地理差异；检查康复护理的比较成本；并为 VA 中风患者开发一个综合的长期康复护理和结果数据库。 方法：这项回顾性研究包括 2006 年 1 月 1 日至 2009 年 12 月 31 日期间被诊断为中风并新入住 CLC 或 CNH 的所有 VA 居民，无论其种族/民族、性别和年龄如何。 CLC 和 CNH 最小数据集 (MDS) 将与不同的 VA 数据集链接，以定义居民的中风诊断并获取研究所需的数据。 对于目标 1，将获得所有变量的描述性统计数据，并将在全国 CLC 和 CNH 之间以及通过 VISN 进行设施和居民特征的比较。 对于目标2，将使用泊松回归或卫生服务利用的两部分模型来分析康复和恢复服务；累积逻辑模型将用于评估情绪行为障碍护理的有序反应。 对于目标 3，我们将评估 CLC 和 CNH 之间从入院到 3、6 和 9 个月的 ADL 功能、认知功能和抑郁变化的差异，并结合证据使用荟萃分析方法评估总体差异。 将拟合死亡率的逻辑回归和中风再住院次数的泊松回归。 目标 2 和 3 分析将进行案例组合风险调整；将在 CLC 和 CNH 的居民之间进行全国和 VISN 比较。 意义：由于中风在退伍军人事务部患者中普遍存在，退伍军人服务的质量和地域差异至关重要。 CLC 和 CNH 是退伍军人长期护理的两个主要来源，VA 继续扩大其长期计划，以满足患有慢性残疾的退伍军人日益增长的需求。 该研究涉及 HSR&D 的两个资助优先类别：长期护理和医疗保健。 这项研究的结果对于退伍军人管理局的政策制定者、临床医生和退伍军人来说非常重要，将使他们能够在未来做出有关将退伍军人适当安置在康复设施中进行中风后护理的决定。 该研究将提供基于证据的信息 关于 CLC 和 CNH 退伍军人居民中风后、机构长期康复护理的质量和地域差异。