Evaluating Policy Solutions Aimed at Improving Hospice Care Access in Rural Areas

项目摘要/摘要 项目4(Gilstrap)：评估旨在改善农村地区临终关怀机会的政策解决方案 2016年，近150万联邦医疗保险受益人参加了临终关怀，同样数量的人，如果不是更多的话 符合条件，但选择不参加。临终关怀可以为病人和照顾者提供无数的好处，并有 事实证明，这会减少生命末期的徒劳护理，使入学人数不足成为一个问题。只有34%的 与城市地区51%的农村死者在临终关怀中登记的比例相比，农村登记人数不足对临终关怀的贡献 在生命末期有更高的急诊率。2016年，医疗保险和医疗补助服务中心(CMS) 推出了医疗保险选择模式(MCCM)。这一自愿计划旨在解决 “可接受性”是临终关怀准入的一个方面，允许患者在不停止治疗的情况下登记进入临终关怀。 对他们的绝症负责。虽然早期的结果表明，该计划增加了注册人数，但减少了 支出方面，目前尚不清楚MCCM项目在农村地区的表现如何，预测的因素是什么 农村地区的成功，以及农村临终关怀机构是否满足了日益增长的服务需求。 该项目将使用相关的、及时的和创新的分析和 方法：研究方法。随着研究小组努力检查MCCM在农村地区的影响，确定残留 在农村地区扩展临终关怀的障碍，并对各种政策解决方案的估计影响进行建模，他们 将利用大型数据集、新颖的人行横道、定性访谈和模拟建模。这项工作 该项目最终将使私人投资公司Gilstrap博士准备开发和提交R01申请，目的是 实施和测试本赠款中确定的战略，以量化其对农村临终关怀登记人数的影响。

PROJECT SUMMARY/ABSTRACT Project 4 (Gilstrap): Evaluating Policy Solutions Aimed at Improving Hospice Care Access in Rural Areas In 2016, almost 1.5 million Medicare beneficiaries enrolled in hospice and an equal number, if not more, were eligible but chose not to enroll. Hospice can provide a myriad of benefits for patients and caregivers, and has been shown to decrease futile care at the end of life, making under-enrollment a problem. With only 34% of rural decedents enrolled in hospice as compared to the 51% in urban areas, rural under-enrollment contributes to a higher rate of acute care at end of life. In 2016, the Center for Medicare and Medicaid Services (CMS) launched the Medicare Care Choices Model (MCCM). This voluntary program aimed to address the “acceptability,” aspect of hospice access, by allowing patients to enroll in hospice without stopping treatment for their terminal condition. Though early results suggest that the program increased enrollment and decreased spending, it remains unclear how the MCCM program performed in rural areas, what factors predicted success in rural areas, and whether increased demand for services was met by rural hospice agencies. This project will investigate these gaps in knowledge using relevant, timely, and innovative analyses and methods. As the research team works to examine the impact of MCCM in rural areas, determine the residual barriers to hospice expansion in rural areas, and model the estimated impacts of various policy solutions, they will leverage large data sets, novel crosswalks, qualitative interviews, and simulation modeling. The work on this project will ultimately prepare the PI, Dr. Gilstrap, to develop and submit an R01 application with the aim of implementing and testing strategies identified in this grant to quantify their impact on rural hospice enrollment.