Medicaid Long-term Care Policies and Rates of Nursing Home Successful Discharge to Community.
Medicaid Long-term Care Policies and Rates of Nursing Home Successful Discharge to Community.
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医疗补助长期护理政策和疗养院成功出院到社区的比率。
DOI：
10.1016/j.jamda.2019.01.153
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发表时间：
2020
影响因子：
7.6
通讯作者：
Intrator,Orna
中科院分区：
文献类型：
--
作者：
Xu,Huiwen;Intrator,Orna
目的护理之家（NH）居民成功出院到社区已被报道在护理之家比较（NHCompare）作为一个质量指标，但它可能是家庭和社区为基础的服务（HCBS）的可用性的影响。医疗补助NH报销率和卧床政策已被证明与护理质量有关，这也可能影响成功出院。本研究探讨了国家医疗补助长期护理政策和成功出院的关系。设计纵向研究医疗补助政策和NH比较成功出院率在3个时间段，2014-2015年，2015-2016年和2016-2017年，使用广义估计方程模型。设置和参与者11，694个独特的NH。测量成功出院的风险调整率从NHCompare下载。Truven的“长期服务和支持的医疗补助支出”报告提供了各州在HCBS和NH上的支出。2014年的卧床政策细节是从医疗补助和芯片支付和访问委员会获得的。NH和市场特征的数据提取自LTCFocUs。地区卫生资源档案。结果2014-2015年、2015-2016年和2016-2017年全国平均调整后出院成功率分别为49.7%、56.8%和56.2%。2015年，各州在HCBS上的支出在30.6%（密西西比）和82.2%（俄勒冈州）之间，总体平均为53.1%。各州平均每居住一天向保健人员偿还185.7美元。HCBS医疗补助支出增加5%与成功出院率增加0.47%具有统计学显著性相关。与报销率在第一个四分位数（≤ 152美元）的国家相比，第二个四分位数（153 - 178美元）、第三个四分位数（179 - 212美元）和第四个四分位数（≥ 213美元）的国家与成功出院率高出2.33%、1.86%和1.15%相关（所有P<0.05）。01）。在没有卧床政策的州，结果更好。结论/影响-这项研究提供了有希望的证据，州政府的支出从机构转移到社区，以及更慷慨的报销，以国家卫生院可能会提高护理质量的国家卫生院。
Objectives Successful discharge of nursing home (NH) residents to community has been reported in Nursing Home Compare (NHCompare) as a quality indicator, yet it is likely influenced by the availability of home-and community-based services (HCBS). Medicaid NH reimbursement rates and bed-hold policies have been shown to be related to quality of care, which may also affect successful discharge. This study explores the relationship of state Medicaid long-term care policies and successful discharge. Design Longitudinal study of Medicaid policies and NHCompare successful discharge rates over 3 time periods, 2014-2015, 2015-2016, and 2016-2017, using generalized estimating equation models. Setting and participants 11,694 unique NHs. Measures Risk-adjusted rates of successful discharge were downloaded from NHCompare. Truven's “Medicaid Expenditures for Long-term Services and Supports” reports provided states' expenditures on HCBS and NHs. Details of bed-hold policies in 2014 were obtained from the Medicaid and CHIP Payment and Access Commission. Data on NH and market characteristics were extracted from LTCFocUs. org and Area Health Resources File. Results The national average-adjusted successful discharge rates were 49.7%, 56.8%, and 56.2% in 2014-2015, 2015-2016, and 2016-2017, respectively. In 2015, states spent between 30.6%(Mississippi) and 82.2%(Oregon) on HCBS, with an overall average of 53.1%. States reimbursed NHs, on average, $185.7 per resident day. Five percent increase in Medicaid spending for HCBS was statistically significantly associated with 0.47% higher successful discharge rates. Compared to NHs in states with reimbursement rates in the first quartile (≤ $152), NHs in the second ($153-$178), third ($179-$212), and fourth (≥ $213) quartiles were associated with 2.33%, 1.86%, and 1.15% higher successful discharge rates (all P<. 01). Results were stronger in states without bed-hold policies. Conclusions/Implications This study provides promising evidence to state governments that shifting expenditures from institutions to communities as well as more generous reimbursements to NHs may improve quality of care in NHs.