RURAL HOSPITAL LINKAGES TO LONG TERM CARE PROVIDERS

农村医院与长期护理提供者的联系

• 批准号: 2442337
• 负责人: MARY L FENNELL
• 金额: $ 27.82万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-08-15 至 2000-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2442337
• 关键词: aging; behavioral /social science research tag; extended care facility; health care cost /financing; health surveys; home health care; hospitals; human subject; interview; rural area

DESCRIPTION: Health care delivery in rural areas has increasingly become more difficult over the past decade. This is related to a number of economic factors and policy changes, including an economic downturn in rural areas, the enactment of the Medicare Prospective Payment System, a shift of patients to urban facilities, higher operating expenses for rural hospitals, and a rapidly evolving industry due to the managed care movement. Moreover, rural hospitals are less able to maintain a staff mix to meet the health care needs of an increasingly older population. Little is known about how rural hospitals coordinate their health care provision with post-acute and LTC providers such as nursing homes and home health agencies. In the face of increasing health care demands in an economically hostile and uncertain environment, rural hospitals have diversified to offer post-acute and long term care through the "swing- bed" program. Hospitals have also established formal ties with LTC providers through a strategy called "vertical integration," where the hospital transfers post-acute and LTC patients to LTC facilities under a formal or informal agreement. Previous research suggests that in rural areas, hospital and LTC links are difficult to establish. Yet it is these links that may be a key to providing cost effective, quality health care to the elderly and disabled who reside in rural areas. This application continues its focus on links between rural hospitals and LTC providers. The expressed aims of the proposed research are fourfold: 1) to develop descriptive data on the extent of linkages between rural hospitals and LTC providers, and the breadth of linkage types which occur between acute and LTC providers; 2) to examine the process of linkage development between acute and LTC providers in relation to "swing-bed" program participation; 3) to test hypotheses about the determinants of linkage structures using Resource Dependence Theory and Institutional Theory; for instance, it is hypothesized that rural hospitals experiencing high cost levels, high variations in cost levels, low Medicare margins, scarce resources and high environmental uncertainty are more likely to seek external linkages with LTC providers; and 4) to test hypotheses about the institutional consequences of linking structures for levels and variation in (a) average Medicare inpatient cost and revenue per admission; and (b) patterns of inpatient care (e.g., length of stay, services received, discharge destination); it is hypothesized that rural hospitals with more formal linkages to LTC providers will experience lower costs and smaller variation in costs than those with informal or no linkages.

描述：农村地区的医疗保健服务日益成为 在过去的十年里更加困难。 这与一些 经济因素和政策变化，包括2009年经济衰退， 农村地区，医疗保险前瞻性支付系统的制定， 病人转移到城市设施， 农村医院，以及由于管理式医疗而迅速发展的行业 运动 此外，农村医院更难以维持一个工作人员 以满足日益老龄化的人口的医疗保健需求。 对于农村医院如何协调他们的医疗保健，人们知之甚少 提供急性后和LTC提供者，如疗养院， 家庭保健机构。 面对日益增长的医疗保健需求， 在经济上充满敌意和不确定的环境中，农村医院 多样化，通过“摇摆”提供急性后和长期护理， 床”计划。 医院也与LTC建立了正式联系 供应商通过一种称为“垂直整合”的战略， 医院将急性期后和长期护理患者转移到长期护理设施， 正式或非正式协议。 以前的研究表明，在农村地区，医院和LTC的联系 很难确定 然而，正是这些联系可能是 为长者提供具成本效益的优质医护服务， 居住在农村地区的残疾人。 该应用程序继续关注农村医院之间的联系 LTC供应商 拟议研究的明确目标是 四方面：1）编制关于联系程度的描述性数据 农村医院和LTC提供者之间的联系，以及联系的广度 急性和LTC提供者之间发生的类型; 2）检查 急性和长期护理提供者之间的联系发展过程 与“摇摆床”计划参与的关系; 3）检验假设 利用资源依赖性理论探讨联系结构的决定因素 理论和制度理论;例如，假设， 农村医院的成本水平高，成本变化大 水平，低医疗保险利润，稀缺资源和高环境 不确定性更有可能寻求与LTC的外部联系 （4）检验关于制度的假设。 （a）中水平和变化的连接结构的后果 每次入院的平均医疗保险住院费用和收入;以及（B） 住院病人护理的模式（例如，停留时间，接受的服务， 出院目的地）;据推测， 与长期护理服务提供者的正式联系将降低成本， 与有非正式联系或没有联系的项目相比，费用差异更大。