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

基本信息

批准号：
10617654
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
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-05-01 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10617654
关键词：
Active Learning Activities of Daily Living Acute Admission activity Age Algorithms Beds Caring Classification 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 Hospitalization 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 United States Work acute care acute stroke 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 timeline tool

项目摘要

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.

项目概要/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由中风引起的。康复。提供最佳的康复服务有助于减轻人们术后的长期残疾。缺乏临床指南，对出院后的长期结果了解甚少。从急性中风护理到住院康复机构 (IRF) 或个人专业护理机构 (SNF) 我们当前的医疗环境需要更快的决策和尽早出院以及结果。可能不适当地出院至 IRF 或 SNF，从而无法为患者提供最佳结果。项目将评估客户（例如中风严重程度、合并症和社会人口统计学）和非客户（例如床位）可用性和保险）在急性住院结束时确定的变量，以确定其中哪些变量与向 IRF 或 SNF 的放电相关（研究目标 1）。确定这些客户变量和非客户变量中的哪些与功能变化相关——基于 AM-PAC 住院病人“6 次点击”基本活动能力、日常活动和短期应用认知工具（之后 IRF 或 SNF 出院）和长期（中风后 6 个月；研究目标 2）。放置到 IRF、SNF 的有效策略，而不是基于客户和非客户的定制策略目标 1（研究目标 3）中确定的变量我们将使用马尔可夫模型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生命年了解结果。这些类似的中风急性后护理环境 (IRF/SNF) 在快速发展的医疗环境中非常重要。这项研究很重要，因为它将提供有关初始客户和非客户变量预测长期的数据。出院后到 IRF 或 SNF 的长期结果，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体验式学习，以支持我的职业发展目标。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），以及成本效益分析（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最终的结果将是改善个人术后的健康状况。中风、减少残疾并降低医疗费用。