Home time and state regulations among Medicare beneficiaries in assisted living communities.
Home time and state regulations among Medicare beneficiaries in assisted living communities.
复制标题
辅助生活社区中医疗保险受益人的家庭时间和州法规。
DOI：
10.1111/jgs.18709
复制
发表时间：
2024
影响因子：
6.3
通讯作者：
Temkin-Greener,Helena
中科院分区：
文献类型：
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作者：
Mao,Yunjiao;Li,Yue;McGarry,Brian;Wang,Jinjiao;Temkin-Greener,Helena
家庭时间是一项重要的以患者为中心的质量指标，但在辅助生活（AL）居民中，这一指标在很大程度上尚未得到检验。我们的目的是评估住院患者在入院后一年内在家时间的变化，并检查直接护理工作者（DCW）培训和人员配备以及持证护士配备的国家法规之间的联系。方法确定2018年进入AL社区的医疗保险受益人，并测量其入院后一年的回家时间。在家时间的计算方法是每天待在家里的时间占活着的时间的百分比。测量了居民特征和国家在DCW人员配置、DCW培训和持证人员配置方面的规定。我们使用具有AL水平固定效应的多元线性回归模型来估计个人水平特征与家庭时间之间的关系。采用调整居民特征的线性回归模型来估计国家法规与居民家庭时间之间的关系。结果研究样本包括12143个ALs的59,831名新的医疗保险受益人居民。在AL入院后的一年中，居民在家的时间占94%（标准差= 14.6）。一些居民特征与较短的在家时间有关：医疗保险-医疗补助双重资格，有更多的慢性疾病，以及特定的慢性疾病，例如痴呆症。在对DCW培训和人员配备具有更大监管特异性，而对持证人员配备的特异性较低的州，居民需要更长的时间来调整家庭时间。结论/意义AL居民的住院时间差异很大，这取决于居民特征和州一级的监管特异性。有资格享受医疗保险和医疗补助的AL居民比只享受医疗保险的居民在家的时间要短得多，这主要是由于他们在养老院呆的时间更长。州航空管理局对DCWs和持证工作人员的监管特异性也影响了航空管理局居民的在家时间。这些发现可以指导人工智能运营商和州立法者努力改善这一重要的生活质量指标。
BackgroundHome time is an important patient‐centric quality metric, which has been largely unexamined among assisted living (AL) residents. Our objectives were to assess variation in home time among AL residents in the year following admission and to examine the associations with state regulations for direct care workers (DCW) training and staffing and for licensed nurse staffing.MethodsMedicare beneficiaries who entered AL communities in 2018 were identified, and their home time in the year following admission was measured. Home time was calculated as the percentage of time spent at home per day being alive. Resident characteristics and state regulations in DCW staffing, DCW training, and licensed staffing were measured. We used a multivariate linear regression model with AL‐level fixed effects to estimate the relationship between person‐level characteristics and home time. Linear regression models adjusting for resident characteristics were used to estimate the association between state regulations and residents' home time.ResultsThe study sample included 59,831 new Medicare beneficiary residents in 12,143 ALs. In the year following AL admission, residents spent 94% (standard deviation = 14.6) of their time at home. Several resident characteristics were associated with lower home time: Medicare–Medicaid dual eligibility, having more chronic conditions, and specific chronic conditions, for example, dementia. In states with greater regulatory specificity for DCW training and staffing, and lower specificity for licensed staffing, residents had longer adjusted home time.Conclusion/ImplicationsHome time varied substantially among AL residents depending on resident characteristics and state‐level regulatory specificity. AL residents eligible for Medicare and Medicaid had substantially shorter home time than the Medicare‐only residents, largely due to longer time spent in nursing homes. State AL regulatory specificity for DCWs and licensed staff also impacted AL residents' home time. These findings may guide AL operators and state legislators in efforts to improve this important quality of life metric.