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Stroke care in academic health centers: Does third party payer type affect equity of physical therapy services and discharge disposition?

机译：学术保健中心的中风护理：第三方付款人类型是否会影响物理治疗服务的公平性和出院安排？

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摘要

Clinical guidelines recommend early mobilization for patients after stroke to prevent complications. Guidelines also recommend discharge to an inpatient rehabilitation facility (IRF), nursing home (NH) or skilled nursing facility (SNF), or home, depending on patients' rehabilitation needs and tolerances. The purpose of this study was to examine whether Medicaid provided equitable access to physical therapy services and discharge disposition following stroke compared to the access provided by private insurance. Aday and Andersen's Behavioral Model was adapted as a theoretical framework of access to care. The study was a retrospective analysis of physical therapy utilization and rehabilitation setting for adults post-stroke under the age of 65. The research involved a cross-sectional analysis of patient-level data from Academic Health Center hospitals obtained from the University HealthSystems Consortium Clinical Database for the years 1999--2002, institutional-level data from the American Hospital Association database, system-level data from the Area Resource File, and a study on relative Medicaid generosity. Research questions were addressed with a combination of logistic regression analysis and ANCOVA. Patients with Medicaid were in poorer health and stayed in the hospital longer than did patients with private insurance. Sixty-two percent of all patients received physical therapy in the hospital following stroke. Patients with Medicaid were more likely to receive Physical Therapy in the hospital (O.R. = 1.357, p .001), and they received more PT (F = 124.94, p .001) than did patients with private insurance. Just over 82% of patients with private insurance and 75% of patients with Medicaid were discharged home. Compared to those with private insurance, patients with Medicaid were more likely to be discharged to a NH rather than home (O.R. = 1.604, p .000). Medicaid Index had a positive association with likelihood of receiving PT (O.R. = 3.914, p .001), amount of PT received (F = 6.00, P = .014), and discharge disposition (O.R. = 7.20, p .002). The influence of the Medicaid Index was not the same across all ethnic/racial groups. Patients with Medicaid have access to PT in the hospital following stroke and are more likely than those with private insurance to receive continued inpatient rehabilitation following hospital discharge. Medicaid generosity makes a difference in PT utilization and discharge disposition post-stroke.
机译：临床指南建议中风后应及早动员以防止并发症。指南还建议根据患者的康复需求和承受能力，出院到住院康复设施（IRF），疗养院（NH）或熟练护理设施（SNF）或家庭。这项研究的目的是检查与私人保险提供的医疗服务相比，医疗补助是否提供了公平的物理治疗服务和中风后出院的服务。 Aday和Andersen的行为模型被改编为获得护理的理论框架。这项研究是对65岁以下成年人卒中后物理疗法的利用和康复环境的回顾性分析。该研究涉及从大学健康系统协会临床数据库获得的学术健康中心医院的患者水平数据的横断面分析在1999--2002年期间，美国医院协会数据库提供了机构级数据，区域资源文件提供了系统级数据，并对医疗补助的相对慷慨进行了研究。研究问题通过逻辑回归分析和ANCOVA结合解决。与有私人保险的患者相比，医疗补助患者的健康状况较差，并且在医院的住院时间更长。中风后，有62％的患者在医院接受了物理治疗。医疗补助患者在医院接受物理疗法的可能性更高（OR = 1.357，p <.001），与私人保险患者相比，他们获得的PT更高（F = 124.94，p <.001）。刚刚超过82％的私人保险患者和75％的医疗补助患者已出院。与拥有私人保险的人相比，医疗补助患者更有可能出院到NH而不是出院（OR = 1.604，p <.000）。医疗补助指数与接受PT的可能性（OR = 3.914，p <.001），接受的PT量（F = 6.00，P = .014）和出院倾向（OR = 7.20，p <.002）呈正相关。 。医疗补助指数对所有种族/种族的影响都不尽相同。患有医疗补助的患者中风后可以在医院接受PT，并且比拥有私人保险的患者更有可能在出院后继续接受住院康复。医疗补助的慷慨性会影响中风后PT的利用和排出的处置。

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  • 作者

    Walker, Martha Lynn.;

  • 作者单位

    Virginia Commonwealth University.;

  • 授予单位 Virginia Commonwealth University.;
  • 学科 Health Sciences Health Care Management.; Health Sciences Rehabilitation and Therapy.
  • 学位 Ph.D.
  • 年度 2005
  • 页码 199 p.
  • 总页数 199
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;康复医学;
  • 关键词

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