Use of Clinicians Who Focus on Nursing Home Care Among US Nursing Homes and Unplanned Rehospitalization.
Use of Clinicians Who Focus on Nursing Home Care Among US Nursing Homes and Unplanned Rehospitalization.
复制标题
DOI：
10.1001/jamanetworkopen.2023.18265
复制
发表时间：
2023-06-01
影响因子：
13.8
通讯作者：
Jung, Hye-Young
中科院分区：
文献类型：
--
作者：
Kim, Seiyoun;Ryskina, Kira L.;Jung, Hye-Young
护理院采用SNFists（即，医生，护士执业者和医生助理将其实践集中在护理院或专业护理机构[SNF]设置）与接受急性期后护理的患者的设施水平，计划外30天再住院率之间的相关性是什么？在这项使用事件研究方法对4482家美国养老院进行的全国性队列研究中，设施采用SNFists与再住院率的统计学显著变化无关。这项研究表明，SNFist的采用可能代表了一种策略，由设施，以保持再住院率，同时转移患者的情况下，对患者接受急性期后护理，这通常会导致更高的利润率为疗养院的组合。专注于疗养院（NHs）实践的医生和高级执业者的数量，通常被称为“SNFists”（即医生，护士执业者和医生助理将其实践集中在疗养院或熟练的护理设施[SNF]设置）急剧增加。关于使用SNFists的NH医疗护理提供模式与急性期后护理质量的关联知之甚少。量化NH使用SNFists与接受急性期后护理的患者的设施水平、计划外30天再住院率之间的相关性。这项队列研究使用了2012年1月1日至2019年12月31日期间出院至4482名NH的所有住院受益人的医疗保险服务费索赔。研究样本包括截至2012年没有接受SNFists护理的患者的NHS。治疗组包括在研究期结束时采用至少1个SNFist的NH。对照组包括在研究期间没有患者接受SNFist治疗的NH。SNFists被定义为全科医生和高级从业者，他们的医疗保险B部分服务的80%或以上在NH提供。于二零二二年一月至二零二三年四月进行统计分析。养老院采用1个或多个SNFist。主要结局是NH 30天计划外再住院率。使用事件研究方法进行了机构级分析，以估计采用1个或多个SNFist的NH与其计划外30天再住院率的相关性，并根据患者病例组合、机构和市场特征进行调整。在次要分析中检查了患者病例组合的变化。在这项对4482个NHS的研究中，SNFist的采用率从2013年的13.5%（4063个中的550个）增加到2018年的52.9%（3656个中的1935个）。采用SNFist后，调整后的再住院率与采用前相比无统计学差异，估计平均治疗效果为0.05个百分点（95% CI，-0.43至0.53个百分点; P = 0.84）。与未采用SNFist的NHS相比，采用SNFist的当年，Medicare覆盖患者的比例增加了0.60个百分点（95%CI，0.21-0.99个百分点; P = .003），采用后1年增加了0.54个百分点（95%CI，0.12-0.95个百分点; P = .01）。采用SNFist后，急性期后入院的人数增加了13.6（95%CI，9.7-17.5; P <0.001），但在视力指数方面没有统计学显著变化。这项队列研究表明，NH采用SNFists与急性期后护理入院人数的增加有关，但与再住院率的变化无关。这可能代表了NHS的一种策略，即保持再住院率，同时增加接受急性后护理的患者数量，这通常会导致更高的利润率。这项队列研究量化了接受急性期后护理的患者在疗养院采用SNFists（即，医生，护士执业者和医生助理集中在疗养院或专业护理机构[SNF]环境中的实践）与机构水平，计划外30天再住院率之间的相关性。
What is the association between nursing home adoption of SNFists (ie, physicians, nurse practitioners, and physician assistants concentrating their practice in the nursing home or skilled nursing facility [SNF] setting) and facility-level, unplanned 30-day rehospitalization rates for patients receiving postacute care? In this national cohort study of 4482 US nursing homes using an event study approach, facility adoption of SNFists was not associated with statistically significant changes in rehospitalization rates. This study suggests that SNFist adoption may represent a strategy by facilities to maintain rehospitalization rates while shifting the patient case mix toward patients receiving postacute care, which typically results in higher profit margins for nursing homes. The number of physicians and advanced practitioners who focus their practice in nursing homes (NHs), often referred to as “SNFists” (ie, physicians, nurse practitioners, and physician assistants concentrating their practice in the nursing home or skilled nursing facility [SNF] setting) has increased dramatically. Little is known about the association of the NH medical care delivery models that use SNFists with the quality of postacute care. To quantify the association between NH use of SNFists and facility-level, unplanned 30-day rehospitalization rates for patients receiving postacute care. This cohort study used Medicare fee-for-service claims for all hospitalized beneficiaries discharged to 4482 NHs from January 1, 2012, through December 31, 2019. The study sample comprised NHs that did not have patients under the care of SNFists as of 2012. The treatment group included NHs that adopted at least 1 SNFist by the end of the study period. The control group included NHs that did not have patients under the care of a SNFist during the study period. SNFists were defined as generalist physicians and advanced practitioners with 80% or more of their Medicare Part B services delivered in NHs. Statistical analysis was conducted from January 2022 to April 2023. Nursing home adoption of 1 or more SNFists. The main outcome was the NH 30-day unplanned rehospitalization rate. A facility-level analysis was conducted using an event study approach to estimate the association of an NH adopting 1 or more SNFists with its unplanned 30-day rehospitalization rate, adjusting for patient case mix, facility, and market characteristics. Changes in patient case mix were examined in secondary analyses. In this study of 4482 NHs, adoption of SNFists increased from 13.5% of facilities (550 of 4063) in 2013 to 52.9% (1935 of 3656) in 2018. Adjusted rehospitalization rates were not statistically different after SNFist adoption compared with before, with an estimated mean treatment effect of 0.05 percentage points (95% CI, −0.43 to 0.53 percentage points; P = .84). The share of Medicare-covered patients increased by 0.60 percentage points (95% CI, 0.21-0.99 percentage points; P = .003) in the year of SNFist adoption and by 0.54 percentage points (95% CI, 0.12-0.95 percentage points; P = .01) 1 year after adoption compared with NHs that did not adopt SNFists. The number of postacute admissions increased by 13.6 (95% CI, 9.7-17.5; P < .001) after SNFist adoption, but there was no statistically significant change in the acuity index. This cohort study suggests that NH adoption of SNFists was associated with an increase in the number of admissions for postacute care but was not associated with a change in rehospitalization rates. This may represent a strategy by NHs to maintain rehospitalization rates while increasing the volume of patients receiving postacute care, which typically results in higher profit margins. This cohort study quantifies the association between nursing home adoption of SNFists (ie, physicians, nurse practitioners, and physician assistants concentrating their practice in the nursing home or skilled nursing facility [SNF] setting) and facility-level, unplanned 30-day rehospitalization rates for patients receiving postacute care.
登录
查看更多内容
影响因子：
10.7
作者：
Baicker, K;Chandra, A
通讯作者：
Chandra, A
影响因子：
6.3
作者：
Sant'Anna, Pedro H. C.;Zhao, Jun
通讯作者：
Zhao, Jun
影响因子：
3
作者：
Thomas KS;Dosa D;Wysocki A;Mor V
通讯作者：
Mor V
DOI：
10.1377/hlthaff.2009.0629
发表时间：
2010-01
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Mor V;Intrator O;Feng Z;Grabowski DC
通讯作者：
Grabowski DC
DOI：
10.1016/j.jamda.2022.03.008
发表时间：
2022-06
影响因子：
7.6
作者：
Jung, Hye-Young;Yun, Hyunkyung;O'Donnell, Eloise;Casalino, Lawrence P.;Unruh, Mark Aaron;Katz, Paul R.
通讯作者：
Katz, Paul R.