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[PMID]:29226443
[Au] Autor:Ellenberg E; Taragin MI; Hoffman JR; Cohen O; Luft-Afik D; Bar-On Z; Ostfeld I
[Ad] Endereço:National Insurance Institute of Israel.
[Ti] Título:Lessons From Analyzing the Medical Costs of Civilian Terror Victims: Planning Resources Allocation for a New Era of Confrontations.
[So] Source:Milbank Q;95(4):783-800, 2017 12.
[Is] ISSN:1468-0009
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Policy Points: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror. CONTEXT: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. Based on an 18-month follow-up of the Israeli civilian population following the 2014 war in Gaza, we describe and analyze the medical costs associated with rocket attacks and review the demography of the victims who filed claims for disability compensation. We then propose practical lessons to help health care authorities prepare for future confrontations. METHOD: Using the National Insurance Institute of Israel's (NII) database, we conducted descriptive and comparative analyses using statistical tests (Fisher's Exact Test, chi-square test, and students' t-tests). The costs were updated until March 30, 2016, and are presented in US dollars. We included only civilian expenses in our analysis. FINDINGS: We identified 5,189 victims, 3,236 of whom presented with acute stress reactions during the conflict. Eighteen months after the conflict, the victims' total medical costs reached $4.4 million. The NII reimbursed $2,541,053 for associated medical costs and $1,921,792 for associated mental health costs. A total of 709 victims filed claims with the NII for further support, including rehabilitation, medical devices, and disability pensions. CONCLUSION: We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror.
[Mh] Termos MeSH primário: Assistência Ambulatorial/economia
Vítimas de Crime/economia
Vítimas de Crime/estatística & dados numéricos
Custos de Cuidados de Saúde/estatística & dados numéricos
Hospitalização/economia
Serviços de Saúde Mental/economia
Centros de Reabilitação/economia
Terrorismo/economia
[Mh] Termos MeSH secundário: Assistência Ambulatorial/estatística & dados numéricos
Hospitalização/estatística & dados numéricos
Seres Humanos
Israel
Serviços de Saúde Mental/estatística & dados numéricos
Centros de Reabilitação/estatística & dados numéricos
Terrorismo/estatística & dados numéricos
Guerra
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1111/1468-0009.12299


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[PMID]:27776422
[Au] Autor:Schmidt E; Schöpf AC; Farin E
[Ad] Endereço:a Faculty of Medicine, Section of Health Care Research and Rehabilitation Research , University of Freiburg , Freiburg , Germany.
[Ti] Título:What is competent communication behaviour of patients in physician consultations? - Chronically-ill patients answer in focus groups.
[So] Source:Psychol Health Med;22(8):987-1000, 2017 Sep.
[Is] ISSN:1465-3966
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Many desirable outcomes depend on good patient-physician communication. Patient-based perspectives of what constitutes competent communication behavior with physicians are needed for patient-oriented health care. Therefore it was our main aim to identify competent patient communication skills from the patient's perspective. We also wanted to reveal any differences in opinion among various groups (chronic ischemic heart disease, chronic low back pain, breast cancer). This study examined nine guideline-supported focus groups in rehabilitation centers. The criterion for study inclusion was any one of the three diagnoses. Enrolled in the study were N = 49 patients (32 women) aged M = 60.1 (SD = 12.8). The interview recordings were transcribed and subjected to content analysis. We documented 396 commentaries in these interviews that were allocated to 82 different codes; these in turn resulted in the formation of 12 main topics. Examples are: posing questions, being an active and participatory patient, being aware of emotions and communicating them. This study represents stage two ('documentation of patient and clinician views') in the seven-stage model of communication research. Findings reveal that chronically-ill patients name behaviours that contribute to successful discussion with a physician. These enable us to develop communication trainings and design-measuring tools used for patient-based communication skills.
[Mh] Termos MeSH primário: Neoplasias da Mama/psicologia
Comunicação
Grupos Focais
Alfabetização em Saúde
Dor Lombar/psicologia
Isquemia Miocárdica/psicologia
Relações Médico-Paciente
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Atitude Frente à Saúde
Neoplasias da Mama/reabilitação
Feminino
Seres Humanos
Dor Lombar/reabilitação
Masculino
Meia-Idade
Isquemia Miocárdica/reabilitação
Participação do Paciente
Centros de Reabilitação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1080/13548506.2016.1248450


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[PMID]:25816380
[Au] Autor:Healy S; Manganelli J; Rosopa PJ; Brooks JO
[Ad] Endereço:Greenville Health System, Greenville, SC, USA.
[Ti] Título:An Exploration of the Nightstand and Over-the-Bed Table in an Inpatient Rehabilitation Hospital.
[So] Source:HERD;8(2):43-55, 2015.
[Is] ISSN:1937-5867
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This study seeks to determine where patients in a rehabilitation hospital keep the greatest percentage of their belongings, that is, in/on the nightstand or on the over-the-bed table. BACKGROUND: This study provides an inventory of patient items located on the over-the-bed table and in/on the nightstand. Understanding the functions of furnishings within the patient room is key for future preparation for designing a next-generation over-the-bed table or for redesigning a more useful nightstand. METHODS: The contents on the top of the nightstand; the contents in the top, middle, and bottom drawers of the nightstand; items next to the nightstand; and the contents on the over-the-bed table within patient rooms were inventoried and placed into categories using similar, patient item categories as the Brooks et al. (2011) study, which examined the contents of the nightstand and the over-the-bed table in assisted living and skilled nursing facilities. RESULTS: Overall, patients in a rehabilitation hospital had a greater percentage of their belongings on the top of the nightstand as compared to their belongings located in all three combined drawers of the nightstand. Overall, patients had a greater percentage of their belongings located on the over-the-bed table as compared to their belongings located on the nightstand. CONCLUSIONS: Tabletop surface area was used extensively in patient rooms at a rehabilitation hospital, but nightstand drawers were underutilized.
[Mh] Termos MeSH primário: Pacientes Internados/psicologia
Decoração de Interiores e Mobiliário/normas
Quartos de Pacientes/normas
Centros de Reabilitação/normas
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Análise de Variância
Feminino
Seres Humanos
Decoração de Interiores e Mobiliário/estatística & dados numéricos
Masculino
Meia-Idade
Quartos de Pacientes/organização & administração
Quartos de Pacientes/estatística & dados numéricos
Centros de Reabilitação/organização & administração
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150328
[St] Status:MEDLINE
[do] DOI:10.1177/1937586714565612


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[PMID]:25816190
[Au] Autor:Campagnol G; Shepley MM
[Ti] Título:Positive distraction and the rehabilitation hospitals of joão filgueiras lima.
[So] Source:HERD;8(1):199-227, 2014.
[Is] ISSN:1937-5867
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This article discusses the use of positive distraction, an evidence-based design approach, in rehabilitation hospitals in Brazil through the work of João Filgueiras Lima ("Lelé"). BACKGROUND: In many parts of the world architects may not formally incorporate theories of positive distraction and evidence-based design, but there are multiple international examples of health facility architects and designers that use nature, daylighting, art, and social interaction to enhance the healing experience. The work of the Brazilian architect João Filgueiras Lima is a particularly salient example. Lima has been a dominant figure in 20th and 21st century Brazilian architecture and the architect of several rehabilitation facilities. METHODS: First positive distraction is defined as it relates to nature and art, and in the context of rehabilitation hospitals. Second, rehabilitation facilities are defined. The discussion then focuses on awareness of evidence-based design in Latin America. Next, Brazilian healthcare architecture is discussed along with the history of the Brazilian Sarah rehabilitation hospitals designed by Lelé and Lelé's role in the history of Brazilian architecture. Last we look at Lelé's use of positive distraction. RESULTS: Despite Lelé's recognition in Brazil, his work has not gained much international exposure. Lelé played a critical role in the design of the Sarah facilities and served on the board of directors for the Technological Center of the Sarah Network (CTRS) in Brazil from 1992 to 2009. Based on our review of his work it was clear that Lelé used positive distraction as a tool for creating healing environments. CONCLUSIONS: In spite of the lack of formal integration of evidence-based design in healthcare architecture in Latin America, many of its basic tenets have been incorporated in Brazilian rehabilitation hospitals. Lelé's projects are a clear example of this phenomenon and demonstrate an alignment between research and practitioner objectives. The presence of nature, art, and natural light in his rehabilitation hospitals serves as a model for evidence-based design in facilities throughout the world and presents an opportunity to measure the benefits of positive distraction on rehabilitation patient outcomes.
[Mh] Termos MeSH primário: Projeto Arquitetônico Baseado em Evidências/métodos
Ambiente de Instituições de Saúde/organização & administração
Arquitetura Hospitalar/métodos
Centros de Reabilitação/organização & administração
[Mh] Termos MeSH secundário: Brasil
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150328
[St] Status:MEDLINE
[do] DOI:10.1177/193758671400800113


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[PMID]:29319943
[Au] Autor:Office of the Secretary, Department of Defense (DoD).
[Ti] Título:TRICARE; Reimbursement of Long Term Care Hospitals and Inpatient Rehabilitation Facilities. Final rule.
[So] Source:Fed Regist;82(249):61678-94, 2017 Dec 29.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This final rule establishes reimbursement rates for Long Term Care Hospitals (LTCHs) and Inpatient Rehabilitation Facilities (IRFs) in accordance with the statutory requirement that TRICARE inpatient care "payments shall be determined to the extent practicable in accordance with the same reimbursement rules as apply to payments to providers of services of the same type under Medicare." This final rule adopts Medicare's reimbursement methodologies for inpatient services provided by LTCHs and IRFs. Each reimbursement methodology will be phased in over a 3-year period. This final rule also removes the definitions for "hospital, long-term (tuberculosis, chronic care, or rehabilitation)" and "long-term hospital care," and creates separate definitions for "Long Term Care Hospital" and "Inpatient Rehabilitation Facility" adopting Centers for Medicare & Medicaid Services (CMS) classification criteria. This final rule also includes authority for a year-end, discretionary General Temporary Military Contingency Payment Adjustment (GTMCPA) for inpatient services in TRICARE network IRFs when deemed essential to meet military contingency requirements.
[Mh] Termos MeSH primário: Planos de Assistência de Saúde para Empregados/economia
Reembolso de Seguro de Saúde/economia
Assistência de Longa Duração/economia
Centros de Reabilitação/economia
Mecanismo de Reembolso/economia
Instituições de Cuidados Especializados de Enfermagem/economia
[Mh] Termos MeSH secundário: Economia Hospitalar
Seres Humanos
Militares
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180122
[Lr] Data última revisão:
180122
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE


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[PMID]:28899328
[Au] Autor:Naylor JM; Hart A; Mittal R; Harris I; Xuan W
[Ad] Endereço:South Western Sydney Clinical School, University of New South Wales, Sydney, NSW Justine.Naylor@sswahs.nsw.gov.au.
[Ti] Título:The value of inpatient rehabilitation after uncomplicated knee arthroplasty: a propensity score analysis.
[So] Source:Med J Aust;207(6):250-255, 2017 Sep 18.
[Is] ISSN:1326-5377
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare the effectiveness of rehabilitation after total knee arthroplasty (TKA) in models with or without an inpatient rehabilitation component. DESIGN, SETTING AND PARTICIPANTS: A propensity score-matched cohort of privately insured patients with osteoarthritis who underwent primary, unilateral TKA in one of 12 Australian hospitals between August 2013 and January 2015 were included. Those discharged to an inpatient facility because of poor progress or who experienced significant complications within 90 days of surgery were excluded. INTERVENTION: Discharge after surgery to an inpatient rehabilitation facility or home. MAIN OUTCOME MEASURES: Patient-reported knee pain and function (Oxford Knee Score; at 90 and 365 days after surgery) and health rating (EuroQol "today" health scale; at 35, 90 and 365 days). Inpatient and community-based rehabilitation provider charges were also assessed. RESULTS: 258 patients (129 pairs) from a sample of 332 were matched according to their propensity scores for receiving inpatient rehabilitation; covariates used in the matching included age, sex, body mass index, and markers of health and impairment. The only significant difference in outcomes was that EuroQol health scores were better on Day 35 for patients not undergoing inpatient rehabilitation (median difference, 5; IQR, -10 to 19; P = 0.01). Median rehabilitation provider charges were significantly higher for those discharged to inpatient therapy (total costs: median difference, $9500; IQR, $7000-11 497; P < 0.001; community therapy costs: median difference, $749; IQR, $0-1980; P < 0.001). CONCLUSIONS: Rehabilitation pathways incorporating inpatient rehabilitation did not achieve better joint-specific outcomes or health scores than alternatives not including inpatient rehabilitation. Given the substantial cost differences, better value alternatives should be considered for patients after uncomplicated TKA.
[Mh] Termos MeSH primário: Artroplastia do Joelho/reabilitação
[Mh] Termos MeSH secundário: Idoso
Artroplastia do Joelho/economia
Feminino
Custos de Cuidados de Saúde/estatística & dados numéricos
Seres Humanos
Pacientes Internados
Masculino
Osteoartrite do Joelho/cirurgia
Pontuação de Propensão
Centros de Reabilitação/economia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170914
[St] Status:MEDLINE


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[PMID]:28863224
[Au] Autor:Cho JS; Hu Z; Fell N; Heath GW; Qayyum R; Sartipi M
[Ad] Endereço:From the Departments of Computer Science and Engineering, Physical Therapy, Health and Human Performance, University of Tennessee, Chattanooga, and Erlanger Health System, Chattanooga, Tennessee.
[Ti] Título:Hospital Discharge Disposition of Stroke Patients in Tennessee.
[So] Source:South Med J;110(9):594-600, 2017 Sep.
[Is] ISSN:1541-8243
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Early determination of hospital discharge disposition status at an acute admission is extremely important for stroke management and the eventual outcomes of patients with stroke. We investigated the hospital discharge disposition of patients with stroke residing in Tennessee and developed a predictive tool for clinical adoption. Our investigational aims were to evaluate the association of selected patient characteristics with hospital discharge disposition status and predict such status at the time of an acute stroke admission. METHODS: We analyzed 127,581 records of patients with stroke hospitalized between 2010 and 2014. Logistic regression was used to generate odds ratios with 95% confidence intervals to examine the factor outcome association. An easy-to-use clinical predictive tool was built by using integer-based risk scores derived from coefficients of multivariable logistic regression. RESULTS: Among the 127,581 records of patients with stroke, 86,114 (67.5%) indicated home discharge and 41,467 (32.5%) corresponded to facility discharge. All considered patient characteristics had significant correlations with hospital discharge disposition status. Patients were at greater odds of being discharged to another facility if they were women; older; black; patients with a subarachnoid or intracerebral hemorrhage; those with the comorbidities of diabetes mellitus, heart disease, hypertension, chronic kidney disease, arrhythmia, or depression; those transferred from another hospital; or patients with Medicare as the primary payer. A predictive tool had a discriminatory capability with area under the curve estimates of 0.737 and 0.724 for derivation and validation cohorts, respectively. CONCLUSIONS: Our investigation revealed that the hospital discharge disposition pattern of patients with stroke in Tennessee was associated with the key patient characteristics of selected demographics, clinical indicators, and insurance status. These analyses resulted in the development of an easy-to-use predictive tool for early determination of hospital discharge disposition status.
[Mh] Termos MeSH primário: Alta do Paciente
Acidente Vascular Cerebral
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Seguro Saúde
Modelos Logísticos
Masculino
Meia-Idade
Casas de Saúde
Centros de Reabilitação
Medição de Risco
Fatores Sexuais
Acidente Vascular Cerebral/complicações
Reabilitação do Acidente Vascular Cerebral
Tennessee
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170902
[St] Status:MEDLINE
[do] DOI:10.14423/SMJ.0000000000000694


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[PMID]:28805358
[Au] Autor:Centers for Medicare & Medicaid Services (CMS), HHS
[Ti] Título:Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2018. Final rule.
[So] Source:Fed Regist;82(148):36238-305, 2017 Aug 03.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2018 as required by the statute. As required by section 1886(j)(5) of the Social Security Act (the Act), this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2018. This final rule also revises the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes that are used to determine presumptive compliance under the "60 percent rule," removes the 25 percent payment penalty for inpatient rehabilitation facility patient assessment instrument (IRF-PAI) late transmissions, removes the voluntary swallowing status item (Item 27) from the IRF-PAI, summarizes comments regarding the criteria used to classify facilities for payment under the IRF PPS, provides for a subregulatory process for certain annual updates to the presumptive methodology diagnosis code lists, adopts the use of height/weight items on the IRF-PAI to determine patient body mass index (BMI) greater than 50 for cases of single-joint replacement under the presumptive methodology, and revises and updates measures and reporting requirements under the IRF quality reporting program (QRP).
[Mh] Termos MeSH primário: Medicare/economia
Sistema de Pagamento Prospectivo/economia
Sistema de Pagamento Prospectivo/legislação & jurisprudência
Centros de Reabilitação/economia
Centros de Reabilitação/legislação & jurisprudência
Reabilitação/economia
Reabilitação/legislação & jurisprudência
[Mh] Termos MeSH secundário: Seres Humanos
Pacientes Internados
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE


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[PMID]:28693436
[Au] Autor:Uchendu O; Oladoyin V; Idowu M; Adeyera O; Olabisi O; Oluwatosin O; Leigh G
[Ad] Endereço:Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria. obioma234@yahoo.co.uk.
[Ti] Título:Urinary schistosomiasis among vulnerable children in a rehabilitation home in Ibadan, Oyo state, Nigeria.
[So] Source:BMC Infect Dis;17(1):487, 2017 Jul 11.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Schistosomiasis is a disease of public health importance with long term complications mostly common among children, rural dwellers, poor and migrant workers. Studies have not documented the burden among migrant workers and their families. The study aimed to describe the burden of schistosomiasis and demographic characteristics among children of migrant workers residing in a rehabilitation home in Ibadan, Nigeria. METHODS: A cross-sectional study using sixty six children, who were tested following complaints of haematuria by six of them. An interviewer-administered questionnaire was used to collect information on demographic and environmental characteristics of the children and urine microscopy, was conducted. Data was analysed using descriptive statistics and correlation. Statistical significance was set at 5%. RESULTS: Mean age of respondents was 11.8 ± 4.0 years and 57.6% were males. The prevalence of schistosomiasis was 19.7% with preponderance among males (64.3%) and children aged 12 years and above (71.4%); 85.7% of infected children were from Kwara State; 78.6% waded in water body and 92.9% had red blood cells and pus cells on urine microscopy. CONCLUSIONS: The burden of schistosomiasis is high among children of migrant workers and they serve as reservoirs for transmission of the disease. Government needs to work synergistically with NGOs, FBOs and other partners to achieve schistosomiasis prevention and control among this particular group.
[Mh] Termos MeSH primário: Esquistossomose Urinária/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Criança
Estudos Transversais
Feminino
Hematúria/parasitologia
Seres Humanos
Masculino
Nigéria/epidemiologia
Prevalência
Centros de Reabilitação
População Rural
Urinálise
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2591-6


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[PMID]:28688653
[Au] Autor:Budnick HC; Tyroch AH; Milan SA
[Ad] Endereço:Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas. Electronic address: hailey.budnick@ttuhsc.edu.
[Ti] Título:Ethnic disparities in traumatic brain injury care referral in a Hispanic-majority population.
[So] Source:J Surg Res;215:231-238, 2017 Jul.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Functional outcomes after traumatic brain injury (TBI) can be significantly improved by discharge to posthospitalization care facilities. Many variables influence the discharge disposition of the TBI patient, including insurance status, patient condition, and patient prognosis. The literature has demonstrated an ethnic disparity in posthospitalization care referral, with Hispanics being discharged to rehabilitation and nursing facilities less often than non-Hispanics. However, this relationship has not been studied in a Hispanic-majority population, and thus, this study seeks to determine if differences in neurorehabilitation referrals exist among ethnic groups in a predominately Hispanic region. METHODS: This study is a retrospective cohort that includes 1128 TBI patients who presented to University Medical Center El Paso, Texas, between the years 2005 and 2015. The patients' age, sex, race, residence, admission Glasgow Coma Scale (GCS), GCS motor, Injury Severity Score (ISS), hospital and intensive care unit length of stay (LOS), mechanism of injury, and discharge disposition were analyzed in univariate and multivariate models. RESULTS: Our study population had an insurance rate of 55.5%. Insurance status and markers of injury severity (hospital LOS, intensive care unit LOS, ISS, GCS, and GCS motor) were predictive of discharge disposition to rehabilitation facilities. The study population was 70% Hispanic, yet Hispanics were discharged to rehabilitation facilities (relative risk: 0.56, P: 0.001) and to long-term acute care/nursing facilities (relative risk: 0.35, P < 0.0001) less than non-Hispanics even after LOS, ISS, ethnicity, insurance status, and residence were adjusted for in multivariate analysis. CONCLUSIONS: This study suggests that patients of different ethnicities but comparable traumatic severity and insurance status receive different discharge dispositions post-TBI even in regions in which Hispanics are the demographic majority.
[Mh] Termos MeSH primário: Lesões Encefálicas Traumáticas/reabilitação
Disparidades em Assistência à Saúde/etnologia
Hispano-Americanos
Alta do Paciente/estatística & dados numéricos
Encaminhamento e Consulta/estatística & dados numéricos
Centros de Reabilitação/utilização
Instituições de Cuidados Especializados de Enfermagem/utilização
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Lesões Encefálicas Traumáticas/etnologia
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Estudos Retrospectivos
Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos
Texas
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170710
[St] Status:MEDLINE



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