Skilled Nursing Facility Participation in Health Information Exchange and Quality of Care for Patients with Alzheimer's Disease and Related Dementias

熟练护理机构参与阿尔茨海默病和相关痴呆症患者的健康信息交流和护理质量

• 批准号: 10467821
• 负责人: Mark Aaron Unruh
• 金额: $ 51.73万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10467821
• 关键词: Address; Admission activity; Adoption; Adverse event; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease related dementia; Area; Back; Caring; Characteristics; Chronic; Clinical; Communities; Cost Savings; Data; Data Element; Data Sources; Dementia; Diagnosis; Discipline of Nursing; Etiology; Event; Fee-for-Service Plans; Frequencies; Health; Health Care Costs; Health Promotion; Home; Hospitalization; Hospitals; Incentives; Income; Individual; Investigation; Length of Stay; Measures; Medical center; Medicare; Medicare/Medicaid; New York; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physicians; Population; Provider; Quality of Care; Race; Research; Research Design; Research Priority; Sampling; Skilled Nursing Facilities; Symptoms; Time; acute care; adverse outcome; base; beneficiary; care coordination; care costs; cost; disparity reduction; dual eligible; functional improvement; health information technology; hospital readmission; improved; incentive program; income disparities; information organization; mortality; novel; payment; prevent; racial disparity; racial minority; readmission rates; residence

PROJECT SUMMARY/ABSTRACT Each year there are 2.4 million skilled nursing facility (SNF) stays for post-acute care among Medicare fee-for- service beneficiaries. Among these patients, over 60% have Alzheimer’s disease or related dementias (ADRD). Following hospitalization, ADRD patients are four times more likely to be discharged to a SNF compared to discharged patients without ADRD. SNF patients with ADRD have worse outcomes than other SNF patients, including higher re-hospitalization rates, longer SNF stays, and a lower likelihood of being discharged back to the community. Insufficient information-sharing capabilities between the SNF, the hospital, and other providers are thought to contribute to the frequency of these events. SNFs were not eligible to receive incentive payments through the Medicare and Medicaid EHR Incentive Programs that led to widespread adoption of health information technology among hospitals and physicians. HIE participation is now being actively promoted by policymakers as means to improve the quality of care in SNFs. However, to date, there is little evidence of its ability to do so for SNF patients overall and no evidence for SNF patients with ADRD. This is likely due to a lack of available data on SNF participation in HIE that includes key information, such as dates of HIE participation. In this project, a novel data source will be used that includes dates of HIE participation for all SNFs participating in HIE in New York State over an eight-year period (2012-2019). These data will be merged with a 100% sample of Medicare fee-for-service claims for all beneficiaries with ADRD in the state who received care in SNFs during the study period to examine the relationship between SNF participation in HIE and the quality and the cost of care for this population. The relationship between SNF participation in HIE and the quality of care will also be examined specifically for dual-eligibles and racial minorities with ADRD, who are more likely to receive fragmented care of lower quality compared to other Medicare beneficiaries. Our research design includes both a difference-in-differences approach based on the timing of SNF participation in HIE and an instrumental variable analysis based on a patient’s residence and the differential distance between the nearest SNF with HIE and the nearest SNF without HIE. The robust study design will allow estimation strongly indicative of causation. The results of the proposed project will be important regardless of our findings. It will be the first investigation of whether HIE participation among SNFs (1) improves the quality of care, (2) lowers health care costs, or (3) reduces income and racial disparities in the quality of care for ADRD patients. The information will be useful to policymakers, SNF and hospital executives, physicians, patients, and leaders of health information exchanges.

项目总结/摘要 每年有240万名熟练护理机构（SNF）在医疗保险收费中进行急性后护理， 服务受益人。在这些患者中，超过60%患有阿尔茨海默病或相关痴呆症 （ADRD）.住院后，ADRD患者出院到SNF的可能性是其他患者的四倍。 与无ADRD的出院患者相比。SNF伴ADRD患者的结局比其他 SNF患者，包括更高的再住院率，更长的SNF停留时间，以及更低的可能性， 出院回到社区。SNF、医院、 而其他供应商被认为是促成这些事件发生频率的因素。SNF没有资格 通过Medicare和Medicaid EHR奖励计划获得奖励金， 医院和医生广泛采用卫生信息技术。HIE参与是 目前，政策制定者正在积极推广，以提高SNF的护理质量。但要 迄今为止，几乎没有证据表明其对SNF患者的整体能力，也没有证据表明SNF患者 ADRD。这可能是由于缺乏SNF参与HIE的可用数据，包括关键信息， 例如HIE参与日期。在这个项目中，将使用一个新的数据源，包括HIE的日期 参与纽约州HIE的所有SNF在八年期间（2012-2019）的参与。这些 数据将与所有ADRD受益人的100%医疗保险服务费索赔样本合并， 在研究期间接受SNF护理的州，以检查SNF与 参与HIE和质量和照顾这一人群的成本。SNF之间的关系 参与HIE和护理质量也将专门针对双杀和种族 少数ADRD患者，与其他人相比，他们更有可能接受质量较低的分散护理 医疗保险受益人我们的研究设计包括基于差异的差异方法， SNF参与HIE的时间和基于患者居住地的工具变量分析， 具有HIE的最近SNF与不具有HIE的最近SNF之间的差分距离。鲁棒性研究 设计将允许估计强烈指示因果关系。拟议项目的结果将是 不管我们的发现如何。这将是第一次调查是否HIE参与SNF (1)提高医疗质量，（2）降低医疗成本，或（3）减少收入和种族差异， ADRD患者的护理质量。这些信息将对政策制定者、SNF和医院管理人员有用， 医生、患者和卫生信息交流的领导者。