Post-acute Care Outcomes of Patients with Alzheimer's Disease and Related Dementias: the Role of Skilled Nursing Facility Specialists

阿尔茨海默病和相关痴呆症患者的急性后护理结果：熟练护理机构专家的作用

• 批准号: 10328560
• 负责人: Hye-Young Jung
• 金额: $ 62.72万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-15 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10328560
• 关键词: Administrator; Admission activity; Affect; Alzheimer' s Disease; Alzheimer' s disease related dementia; Caring; Characteristics; Clinical; Clinical assessments; Communication; Communities; Complex; Continuity of Patient Care; Data; Data Set; Databases; Dementia; Emergency department visit; Employment; Fee-for-Service Plans; Goals; Grant; Growth; Health care facility; Hospitalization; Hospitals; Human Resources; Intervention; Interview; Length of Stay; Link; Long-Term Care; Measures; Medicare; Medicare claim; Nurse Administrator; Nursing Homes; Nursing Staff; Outcome; Ownership; Patient Care; Patient-Focused Outcomes; Patients; Penetration; Persons; Physician Executives; Physicians; Play; Policies; Prevalence; Process; Recovery; Research; Role; Sampling; Site; Skilled Nursing Facilities; Specialist; Structure; Training; Visit; Work; acute care; base; beneficiary; care coordination; care delivery; care outcomes; cost; evidence base; experience; functional outcomes; functional status; health care service utilization; hospital readmission; hospitalization rates; improved; improved outcome; loss of function; memory care; readmission rates; residence; therapy development; trend

PROJECT SUMMARY Over 1.1 million patients admitted annually to skilled nursing facilities (SNFs) for post-acute care after a hospitalization have Alzheimer’s Disease or Related Dementias (ADRD), and their outcomes are poor and variable. Given the high clinical complexity and care coordination needs of patients with ADRD, one potential solution to improving the outcomes of patients with ADRD receiving SNF care is through physicians who specialize in SNF-based care. “SNFists” (i.e., physicians for whom SNF patients comprise the majority of their practice) are becoming increasingly common. Our prior work found a 37% increase in the prevalence of SNFists from 2012 to 2015, with a high degree of variability across markets. In this study, we will examine whether physicians specializing in SNF-based care improve functional outcomes and reduce potentially avoidable healthcare utilization (such as hospital readmissions) of patients with ADRD receiving post-acute care in SNFs. To accomplish these goals, we will expand an existing dataset of Medicare claims and SNF clinical assessment data for Medicare fee-for-service beneficiaries discharged from an acute care hospital to a SNF from 2012 through 2019. Using this database, we will examine the trends in physician specialization in SNF care in the context of market, facility, and physician characteristics. Next, we will measure the impact of physician specialization in SNF care on the outcomes and healthcare utilization of patients with ADRD using difference-in-differences cross-temporal matching. Lastly, we will conduct semi-structured interviews with key SNF personnel (e.g., director of nursing, medical director) to quantitatively identify practice strategies and care processes that differ between physicians in high- vs. low-performing SNFs based on the outcomes of patients with ADRD. When complete, these studies will inform practice and policy to optimize (increase or reduce) post- acute care patients’ access to physicians who specialize in SNF-based care. The findings will be used to develop interventions to improve the value of SNF-based post-acute care for patients with ADRD.

项目总结