Aims: The assessment of functional status is a more appropriate measure in the older people than traditional healthcare outcomes. The present study aimed to analyse the association between functional status assessed using the Barthel Index and length of stay, in-hospital mortality, discharge destination, and Diagnosis-Related Groups-based cost.
Design: This study was a retrospective study that used administrative data from patients older than 65 discharged from the University Hospital of Padua (Italy) in 2016.
Methods: A logistic regression model for categorical variables (length of stay, in-hospital mortality, and discharge destination) and a generalized linear model with gamma distributions and log links for continuous variables (cost of hospitalization) were used to evaluate associations with the Barthel Index.
Results: A total of 13,484 admissions were included in the analysis. In-hospital mortality, safe discharge, and length of stay were higher in patients with severe dependence than in patients with mild/no dependence with a 12-fold increased risk of death (OR = 12.81; 95% CI 9.22-18.14), a 4 times greater likelihood of safe discharge (OR = 4.64; 95% CI 3.96-5.45), and a 2-fold increase in length of stay (OR = 2.56; 95% CI 2.34-2.81). On the other hand, no significant association was found between the cost of hospitalization and the Barthel Index.
Conclusions: Barthel Index was strongly associated with in-hospital mortality, discharge destination, and length of stay. The costs of hospitalization, however, were not related to patients' functional impairment.
Impact: The study considers functional status as an indicator of hospital outcomes. Better comprehension of the relationship between functional status and healthcare outcomes may help with early and adequate healthcare planning and resource management.
目的: 对老年人来说, 与传统医疗保健结果相比, 功能状态评价是一项更合适的衡量指标。本研究旨在分析使用Barthel指数评价的功能状态与住院时间、住院死亡率、出院目的地和基于诊断相关群体的费用之间的相关性。 设计: 本研究是一项回顾性研究, 使用了2016年帕多瓦大学医院 (意大利) 65岁以上出院患者的管理数据。 方法: 采用分类变量 (住院时间、住院死亡率和出院目的地) 的逻辑回归模型和连续变量 (住院费用) 的伽马分布和对数关联的广义线性模型来评估与Barthel指数的相关性。 结果: 分析中共纳入了13,484例。严重依赖患者的住院死亡率、安全出院和住院时间均高于轻度/无依赖患者, 死亡风险增加12倍 (OR=12.81;95% CI 9.22-18.14) , 安全出院的可能性增加4倍 (OR=4.64;95% CI 3.96-5.45) , 住院时间增加2倍 (OR=2.56;95% CI 2.34-2.81) 。另一方面, 住院费用与Barthel指数之间没有发现显著相关性。 结论: Barthel指数与住院死亡率、出院目的地和住院时间密切相关。不过, 住院费用与患者的功能障碍无关。 影响: 本研究认为功能状态是出院结局的一个指标。更好地理解功能状态与医疗结果之间的关系, 可能有助于早期充分的医疗规划和资源管理。.
Keywords: Barthel Index; hospital related; nurses; nursing; older patient; outcomes; physical function.
© 2020 John Wiley & Sons Ltd.