How Much is Post-Acute Care Use Affected by its Availability?
How Much is Post-Acute Care Use Affected by its Availability?
复制标题
急性后期护理的使用受到其可用性的影响有多大？
DOI：
10.3386/w10424
复制
发表时间：
2004
期刊：
影响因子：
2.1
通讯作者：
J. Escarce
中科院分区：
文献类型：
--
作者：
Melinda Buntin;A. Garten;S. Paddock;D. Saliba;M. Totten;J. Escarce
OBJECTIVE
To assess the relative impact of clinical factors versus nonclinical factors-such as postacute care (PAC) supply-in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care.
DATA SOURCES AND STUDY SETTING
Medicare acute hospital, IRF, and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data.
STUDY DESIGN
We used multinomial logit models to predict PAC use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements.
DATA COLLECTION/EXTRACTION METHODS
A file was constructed linking acute and postacute utilization data for all medicare patients hospitalized in 1999.
PRINCIPAL FINDINGS
PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there.
CONCLUSIONS
We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes-or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes.
引入预期支付系统之前和之后使用医疗保险服务。
影响因子：
3.4
作者：
Manton,KG;Woodbury,MA;Vertrees,JC;Stallard,E
通讯作者：
Stallard,E
老年人急性心肌梗塞后急性后服务的使用。
影响因子：
--
作者：
Bronskill,SusanE;Normand,Sharon-LiseT;McNeil,BarbaraJ
通讯作者：
McNeil,BarbaraJ