Non-acute Care For Cardiorespiratory Issues
Post-acute care (PAC) is available for older adults who need additional services after hospitalization for acute cardiac events. With the aging population and an increase in the prevalence of cardiac disease, it is important to determine current PAC use for cardiac patients to assist health care workers to meet the needs of older cardiac patients. The purpose of this study was to determine the current PAC use and factors associated with PAC use for older adults following hospitalization for a cardiac event that includes coronary artery bypass graph (CABG) and valve surgeries, myocardial infarction (MI), percutaneous coronary intervention (PCI), and heart failure (HF) Non-acute Care For Cardiorespiratory Issues
A cross-sectional design and the 2003 Medicare Part A database were used for this study. The sample (n=1,493,521) consisted of patients aged 65 years and older discharged after their first cardiac event. Multinomial logistic regression was used to examine factors associated with PAC use. Overall, PAC use was 55% for cardiac valve surgery, 50% for MI, 45% for HF, 44% for CABG, and 5% for PCI. Medical patients use more skilled nursing facility care and surgical patients use more home health care. Only 0.1–3.4% of the cardiac patients use intermediate rehabilitation facilities. Compared to those who do not use PAC, those who use home health care and skilled nursing facility care are older, female, have a longer hospital length of stay, and more comorbidity. Asians, Hispanics and Native Americans were less likely to use PAC after hospitalization for an MI or HF. Non-acute Care For Cardiorespiratory Issues
The current rate of PAC use indicates that almost half of non-disabled Medicare patients discharged from the hospital following a cardiac event use one of these services. Healthcare professionals can increase PAC use for Asians, Hispanics and Native Americans by including culturally targeted communication. Optimizing recovery for cardiac patients who use PAC may require focused cardiac rehabilitation strategies.
The Agency for Healthcare Research and Quality recently reported that post-acute care (PAC) use after hospitalization in the United States has risen 30% for skilled nursing facilities (SNF) and intermediate rehabilitation facilities (IRF), and 53% for home health care (HHC).1 Currently, one-third of adults age 65 and older use PAC after a hospitalization,2, 3 yet the current rate of PAC use for cardiac patients 65 years of age and older has not been reported. Patients who use PAC receive traditional rehabilitation services that focus on improvement of activities of daily living through physical and occupational therapy and education. For cardiac patients, additional rehabilitation services are needed for optimal recovery that are specific to their cardiac event, such as monitoring the cardiac response to therapy, learning self-management of cardiac symptoms and lifestyle changes, survival management, and cardiac education.4 Unfortunately traditional PAC services do not include these cardiac-specific services for older adults following a cardiac event that includes hospitalization for coronary artery bypass graph (CABG) and cardiac valve surgeries, myocardial infarction (MI), percutaneous coronary interventions (PCI) and heart failure (HF).Non-acute Care For Cardiorespiratory Issues
The rate of PAC use and the factors associated with PAC use are important. Specifically, factors associated with PAC use can be used to assist in the early identification of patients likely to use PAC to ensure adequate planning for discharge and efficient transitions. The rate of PAC use can be used to justify standardization of interventions to address common cardiac recovery issues across the transitions of care and during PAC. The current study was designed to determine the rate of PAC service use by cardiac patients and to identify the characteristics of cardiac patients who use PAC services. This study is the first step in the understanding of the need to integrate a full range of cardiac-specific services to enhance recovery during PAC. Non-acute Care For Cardiorespiratory Issues
Heart disease is the leading cause of hospitalization in the U.S.6 and the majority of patients with a cardiac event or procedure are over the age of 65.7, 8 Post-acute care is available to patients over 65 through the Medicare program and services include therapy (physical, occupational, and speech) and skilled nursing care.9 Services are provided in skilled nursing facilities (SNF), intermediate rehabilitation facilities (IRF), and through home health care agencies (HHC). The type of PAC that is selected (e.g. HHC versus SNF) is usually determined by the functional status of the patient, the availability of informal caregivers, and the availability of PAC services.2, 3 For example, patients who have minimal functional impairments and have a caregiver may use HHC; however, older adults who have physical limitations and do not have a caregiver generally use a SNF. In contrast, use of an IRF requires meeting specific admission criteria such as need for physical, occupational, and speech therapies, and the ability to tolerate three hours of therapy a day10 In addition, IRFs must admit 60% of their patients from specific diagnoses such as stroke, spinal cord injury, amputation, or major trauma.11 Thus, IRF care is reserved for diagnoses traditionally considered to be “rehabilitative conditions” and require more than 2 rehabilitative therapies Non-acute Care For Cardiorespiratory Issues
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