Medicare's hospice benefit: analysis of utilization and resource use.
Medicare's hospice benefit: analysis of utilization and resource use.
复制标题
DOI：
10.5600/mmrr.004.02.b03
复制
发表时间：
2014-01-01
期刊：
影响因子：
--
通讯作者：
Stearns, Sally C
中科院分区：
文献类型：
--
作者：
Bogasky, Susan;Sheingold, Steven;Stearns, Sally C
目的：这项工作提供了临终关怀用户的描述性统计。它还探讨了临终关怀发作期间的相对资源使用的幅度，以及这种模式是否因只使用常规家庭护理的患者与使用多层次临终关怀的患者相比的发作长度而异。检查在一次发作中需要不同临终关怀护理水平的临终关怀用户的资源使用与仅常规家庭护理相比，提供了对与不同患者群体相关联的各种资源使用的洞察（即，那些在整个事件中需要稳定的常规家庭护理的人与那些在整个事件中需要不同水平护理的人）。数据来源：分析基于纵向分析文件，该文件由2008年9月1日至2011年年底完成事件的临终关怀用户的100% Medicare索赔构成。在检查常规家庭护理使用者和各级临终关怀的资源使用时，分析仅限于2010年4月1日或之后开始临终关怀发作的单次发作死亡者，其死亡日期为2011年12月31日或之前。每日工资加权访问单位（WWVU）计算每个病人在他们的临终关怀停留。为了计算WWVU，每个访问学科的四分之一的劳工统计局小时工资率（即，熟练的护理，医疗社会服务，家庭健康助理，平均治疗）乘以相应的访问单位数量上报告的临终关怀claims.PRINCIPAL调查结果：使用增强的数据强度的服务使用，结果证实了以前的研究，提出了一个弯曲的模式，以服务使用在临终关怀发作。对于几个措施的资源密集度，服务使用更密集的最初几天在事件和死亡前的最后几天相对于中间的日子。随着发作时间的增加，该模式变得更加明显，但当与诊断进行比较时，则是类似的曲线。因此，研究结果提供了有用的信息，潜在的政策讨论医疗临终关怀改革。
OBJECTIVE: This work provides descriptive statistics on hospice users. It also explores the magnitude of relative resource use during hospice episodes and whether such patterns vary by episode length for patients who only use routine home care as compared to those who use multiple levels of hospice care. Examining resource use for hospice users who require different hospice levels of care within an episode versus solely routine home care provides insight to the varied resource use associated with the different patient populations (i.e., those who may require steady routine home care across the entire episode versus those who require varied levels of care across the episode).DATA SOURCE: The analyses were based on a longitudinal analytic file that was constructed from 100% of Medicare claims for hospice users with completed episodes spanning September 1, 2008 through the end of calendar year 2011. In examining resource use for routine home care users and all levels of hospice care, the analyses were restricted to single episode decedents who began their hospice episode on or after April 1, 2010 and whose date of death was on or before December 31, 2011. Daily wage-weighted visit units (WWVUs) were calculated for each patient during their hospice stay. In order to compute a WWVU, one-fourth of the Bureau of Labor Statistics hourly wage rate for each visit discipline (i.e., skilled nursing, medical social services, home health aide, and an average for therapies) was multiplied by the corresponding number of visit units reported on hospice claims.PRINCIPAL FINDINGS: Using enhanced data on the intensity of service use, the results confirm previous research that suggested a curved pattern to service use during a hospice episode. For several measures of resource intensity, service use is more intensive during the initial days in the episode and for the last few days prior to death relative to the middle days of the episode. The pattern becomes more pronounced as episodes increase in length, but is otherwise a similar curve when compared by diagnosis. Thus, the results provide useful information for potential policy discussions about Medicare hospice reform.