Hospitalization of nursing home residents: The effects of states' Medicaid payment and bed-hold policies
Hospitalization of nursing home residents: The effects of states' Medicaid payment and bed-hold policies
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DOI：
10.1111/j.1475-6773.2006.00670.x
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发表时间：
2007-08-01
影响因子：
3.4
通讯作者：
Mor, Vince
中科院分区：
文献类型：
--
作者：
Intrator, Orna;Grabowski, David C.;Mor, Vince
Objective.疗养院居民住院费用昂贵，使居民面临医源性疾病以及社会和心理伤害。假设医疗费用支付者（主要是医疗补助政策）施加的经济限制会影响住院率。数据来源/研究设置。联邦授权的居民评估与医疗保险索赔和资格文件合并，以确定基线评估后150天内的住院和死亡情况。养老院和市场的特点，分别从网上调查认证和报告，和地区资源文件。国家的平均每日医疗补助养老院支付和床位持有政策独立获得。2000年4月至6月，对8,997家城市独立式疗养院的570,614名老年（≥ 65岁）、非MCO（医疗保险管理护理）、长期住院（≥ 90天）居民进行了前瞻性队列研究，使用多水平模型测试了国家政策对住院的影响，控制了居民、疗养院和市场特征。总的来说，99,379名（17.4%）居民住院，住院率从犹他州的8.4%到路易斯安那州的24.9%不等。较高的每日医疗补助与较低的住院几率相关（平均103.5美元以上每增加10美元，住院几率降低5%，置信区间[CI] 0.91-0.99）。在有卧床政策的州，住院几率高出36%（CI：1.12-1.63）。国家医疗补助床位持有政策和按日支付有重要影响的疗养院住院，这主要是由医疗保险。这项研究强调了在养老院环境中，适当调整州医疗补助和联邦医疗保险政策对急性、维持和预防性护理补贴的重要性。
Objective. Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations.Data Sources/Study Setting. Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently.Study Design. Prospective cohort study of 570,614 older (>= 65-year-old), non-MCO (Medicare Managed Care), long-stay (>= 90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics.Principal Findings. Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63).Conclusions. State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.