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

项目总结 每年有超过110万名患者进入熟练护理设施(SNF)接受急性后护理 住院患有阿尔茨海默病或相关痴呆症(ADRD)，他们的结果很差， 变量。鉴于ADRD患者高度的临床复杂性和护理协调需求，一个潜在的 改善接受SNF护理的ADRD患者结局的解决方案是通过以下医生 专门从事以SNF为基础的护理。“SNFist”(即，SNF患者占其大多数的医生 实践)正变得越来越普遍。我们之前的工作发现，患病率上升37% SNFI从2012年到2015年，在不同市场之间具有高度的变异性。在这项研究中，我们将检查 专攻基于SNF的护理的医生是否改善了功能结果，并降低了潜在的 急性呼吸窘迫综合征患者急诊后可避免的医疗利用(如再入院) 在SNF中护理。为了实现这些目标，我们将扩展现有的Medicare Claims和SNF数据集 从急诊医院出院到医院的医疗保险服务费用受益人的临床评估数据 从2012年到2019年。使用这个数据库，我们将检查#年医生专业化的趋势 在市场、设施和医生特征的背景下的SNF护理。接下来，我们将衡量 SNF护理的专科医生对ADRD患者结果和医疗利用的影响 差分跨时相匹配。最后，我们将对Key进行半结构化采访 SNF人员(例如，护理主任、医务主任)，以定量确定实践策略和护理 根据患者的结果，在高性能SNF和低性能SNF中，医生之间的流程不同 和ADRD在一起。完成后，这些研究将为实践和政策提供信息，以优化(增加或减少)岗位 急症护理患者能够接触到专门从事基于SNF的护理的医生。这些发现将被用来 制定干预措施，以提高基于SNF的急性后护理对ADRD患者的价值。

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.