Health Care Use After Functional Disability: Opportunities to Improve the Care of Older Adults

功能性残疾后的医疗保健使用:改善老年人护理的机会

基本信息

项目摘要

PROJECT SUMMARY/ABSTRACT Functional disability profoundly impacts the health and health care use of older adults, and yet functional status is not consistently monitored by health systems, nor routinely collected by Medicare. Patients and their families frequently struggle with inadequate support for these unrecognized needs. While specific diseases or multimorbidity have traditionally been the focus of research investigating high and potentially burdensome health care use, disability, defined as needing help performing activities of daily living (ADLs), may be a more critical and universal factor. The relationship between disability and health care use is complex: medical conditions may result in both disability and health care use, disability and unmet care needs can lead to health care use, and hospitalization itself can cause disability. Variation in health system features and practice patterns, such as the numbers of hospital beds and local levels of health care intensity, impact care patterns at a regional level and may influence the relationship between disability and health care use. Nationally, the Medicare Advantage (MA) program is rapidly expanding and offers increasing flexibility in supplemental benefits that could better support older adults with disability. However, older adults with functional disability are more likely leave MA plans and may receive care from lower quality skilled nursing facilities and home health agencies in MA. It is unknown if MA plans are shifting care from facilities to the community and to unpaid caregivers in order to reduce costs. The Paul Beeson Emerging Leaders Career Development Award in Aging will support my effort to address this gap through research that will examine the relationship between disability and health care use at three levels: the individual, health system, and health policy. In SA1, I will investigate the individual-level heterogeneity of health care use after the first report of ADL disability using the Medicare claims-linked National Health and Aging Trends Study (NHATS), which allows for identification of the month of disability onset. In SA2, I will use the Health and Retirement Study and data capturing regional characteristics to assess the influence of regional health system features on health care use after disability. In SA3, I will use NHATS linked to Medicare data to examine differences in care setting (i.e., community vs. institutional care) and caregiving (i.e., paid and unpaid caregiving) between older adults with functional disability in MA vs. traditional Medicare. These scientific aims link closely with a comprehensive development plan through which I will gain advanced methodological expertise in trajectory analysis and hierarchical modeling, clinical and systems understanding in geriatric disability, health economics and policy insight, and the leadership skills to translate my findings to policy change. This five-year project leverages my extensive experience conducting survey-based research, the resources of my institution, and the expertise of my mentors to identify opportunities to improve the care of older adults while catalyzing my development as an independent researcher working to improve Medicare policy for older adults with functional disability.
项目概要/摘要 功能障碍深刻影响老年人的健康和医疗保健使用,但功能状态 卫生系统没有持续监测,医疗保险也没有定期收集。患者及其家属 经常因对这些未被认识到的需求的支持不足而苦苦挣扎。虽然特定疾病或 传统上,多重发病率一直是调查高且潜在负担的研究重点 医疗保健使用、残疾(定义为需要帮助进行日常生活活动 (ADL))可能是一个更重要的问题 关键和普遍因素。残疾与医疗保健使用之间的关系很复杂:医疗 情况可能会导致残疾和医疗保健的使用,残疾和未满足的护理需求可能会导致健康 护理使用和住院本身可能会导致残疾。卫生系统特征和实践的差异 模式,例如医院床位数量和当地医疗保健强度水平,影响着医疗保健模式 区域层面,可能会影响残疾与医疗保健使用之间的关系。在全国范围内, Medicare Advantage (MA) 计划正在迅速扩大,并在补充方面提供越来越大的灵活性 可以更好地支持残疾老年人的福利。然而,患有功能障碍的老年人 更有可能离开 MA 计划,并可能接受质量较低的熟练护理机构和家庭保健机构的护理 马萨诸塞州的机构。目前尚不清楚 MA 计划是否会将护理从设施转移到社区并无偿提供 照顾者,以降低成本。保罗·比森老龄化领域新兴领袖职业发展奖 将支持我通过研究来解决这一差距的努力,该研究将审查残疾之间的关系 以及三个层面上的医疗保健使用:个人、卫生系统和卫生政策。在SA1中,我将调查 使用医疗保险首次报告 ADL 残疾后,个人层面的医疗保健使用存在异质性 与索赔相关的国家健康和老龄化趋势研究 (NHATS),该研究可以识别索赔月份 残疾发作。在 SA2 中,我将使用健康与退休研究和捕获区域特征的数据 评估区域卫生系统特征对残疾后医疗保健使用的影响。在SA3中,我将使用 NHATS 与 Medicare 数据相关联,以检查护理环境的差异(即社区与机构护理) 以及 MA 与功能障碍老年人之间的护理(即有偿和无偿护理) 传统医疗保险。这些科学目标与全面的发展计划密切相关,我通过该计划 将获得轨迹分析和分层建模、临床和 对老年残疾、卫生经济学和政策洞察力的系统理解,以及领导技能 将我的发现转化为政策变化。这个为期五年的项目利用了我丰富的经验 基于调查的研究、我所在机构的资源以及我导师的专业知识来确定 有机会改善对老年人的护理,同时促进我作为独立人士的发展 研究人员致力于改善功能障碍老年人的医疗保险政策。

项目成果

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Claire Kathryn Ankuda其他文献

Claire Kathryn Ankuda的其他文献

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{{ truncateString('Claire Kathryn Ankuda', 18)}}的其他基金

Health Care Use After Functional Disability: Opportunities to Improve the Care of Older Adults
功能性残疾后的医疗保健使用:改善老年人护理的机会
  • 批准号:
    10633250
  • 财政年份:
    2020
  • 资助金额:
    $ 24.27万
  • 项目类别:
Health Care Use After Functional Disability: Opportunities to Improve the Care of Older Adults
功能性残疾后的医疗保健使用:改善老年人护理的机会
  • 批准号:
    10259713
  • 财政年份:
    2020
  • 资助金额:
    $ 24.27万
  • 项目类别:
Health Care Use After Functional Disability: Opportunities to Improve the Care of Older Adults
功能性残疾后的医疗保健使用:改善老年人护理的机会
  • 批准号:
    10045778
  • 财政年份:
    2020
  • 资助金额:
    $ 24.27万
  • 项目类别:

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