Do Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations Impact End-of-Life Quality and Cost of Care?

项目总结/摘要 这是一个K 01指导研究科学家发展奖提交给国家 人口健康科学系讲师罗伯特泰勒布劳恩的老龄化研究所 威尔康奈尔医学院（Weill Cornell Medical College，WCMC）布劳恩博士的职业目标是成为一名独立的 通过评估各种政策干预措施改善老年人临终护理的研究员， 临终关怀的交付模式。此K 01应用程序将为Braun博士提供必要的培训 1)2）了解临终关怀病人的临床护理; 以及3）获得进行与临终关怀服务和护理相关的定性研究的方法技巧。 Braun博士组建了一个由来自WCMS的有成就的研究人员组成的导师团队， 范德比尔特大学医学院（VUSM）：Lawrence卡萨利诺博士（主要导师）， 利文斯顿法兰德教授公共卫生在世界养护监测中心和专家对卫生保健组织和 行为和定性方法;冬青Prigerson博士（共同导师）谁是欧文舍伍德赖特 WCMC老年医学教授和临终关怀专家;大卫史蒂文森博士（共同导师）， 是一位教授和保持器的捐赠董事在卫生政策教育在VUMC和 在临终关怀的交付专家;和博士马克Unruh（共同导师）谁是副教授在 WCMC的人口健康科学部在长期护理和医疗保险方面拥有专业知识， 索赔数据。 在过去的几十年里，临终关怀行业已经从一个主要的非营利组织， 以营利为主导的行业。由于相对容易的市场准入和慷慨的医疗保险， 支付，PE公司和PTC一直在收购临终关怀（其中许多是非营利性的），目标是 为投资者提供短期高于市场的回报。尽管出现了这种情况，但人们对其知之甚少。 对临终关怀的影响根据他以前在评估这一现象方面的研究和培训， 医生的做法，布劳恩博士将确定组织，人员配备，病人，和质量 使用来自中心的公开可用临终关怀数据与PE和PTC收购相关的特征 对于医疗保险和医疗补助服务（CMS）（目标1），使用严格的计量经济学方法来评估 使用患者级医疗保险索赔（目标2）对临终关怀进行PE和PTC收购的影响，以及使用 定性方法来评估收购后的临终关怀的组织，文化和交付方面 整合（目标3）。这项研究将是R 01赠款申请的基础，并将纳入 通过培训获得的新技能，为改善临终关怀提供了机会 提供护理。

PROJECT SUMMARY/ABSTRACT This is a K01 Mentored Research Scientist Development Award submitted to the National Institute on Aging by Robert Tyler Braun, an Instructor in the Department of Population Health Sciences at Weill Cornell Medical College (WCMC). Dr. Braun's career goal is to become an independent researcher on improving end-of-life care for the elderly by assessing various policy interventions and delivery models of hospice care. This K01 application will provide Dr. Braun with the necessary training 1) to gain expertise in aging and hospice research; 2) to understand clinical care for hospice patients; and 3) to gain methodological skills to conduct qualitative studies related to hospice delivery and care. Dr. Braun has assembled a mentor team of accomplished researchers from WCMS and Vanderbilt University School of Medicine (VUSM): Dr. Lawrence Casalino (primary mentor) who is the Livingston Farrand Professor of Public Health at WCMC and an expert on health care organization and behavior, and qualitative methods; Dr. Holly Prigerson (co-mentor) who is the Irving Sherwood Wrights Professor of Geriatrics at WCMC and an expert on end-of-life care; Dr. David Stevenson (co-mentor) who is a professor and the holder of the Endowed Directorship in Health Policy Education at VUMC and an expert in the delivery of hospice care; and Dr. Mark Unruh (co-mentor) who is an Associate Professor in the Department of Population Health Sciences at WCMC with expertise in long-term care and Medicare claims data. Over the past couple of decades, the hospice industry has moved from largely a not-for-profit sector to predominately for-profit. Facilitated by relatively easy market entry and generous Medicare payments, PE firms and PTCs have been acquiring hospices (many of them non-profit), with the goal to deliver short-term, above market returns to their investors. Despite this emergence, little is known of its effect on hospice care. Building on his previous research and training on assessing this phenomenon in physician practices, Dr. Braun will identify the organizational, staffing, patient, and quality characteristics associated with PE and PTC acquisitions using publicly available hospice data from Center for Medicare and Medicaid Services (CMS) (Aim 1), use rigorous econometric methods to assess the effect PE and PTC acquisition on hospice care using patient-level Medicare claims (Aim 2), and use qualitative methods to assess organizational, cultural, and delivery aspects of hospices post-acquisition integration (Aim 3). This research will be a foundation for an R01 grant application and will incorporate the new skills acquired through his training, which inform opportunities for improvement in hospice delivery of care.