RURAL HOSPITAL LINKAGES TO LONG TERM CARE PROVIDERS

描述：农村地区的医疗保健服务日益成为 在过去的十年里变得更加困难。这与许多 经济因素和政策变化，包括#年经济下滑 农村地区，医疗保险预期支付制度的颁布， 患者转移到城市设施，更高的手术费用 乡村医院，以及由于管理式医疗而迅速发展的行业 有动静。此外，乡村医院维持工作人员的能力较差 混合，以满足日益增长的老年人口的医疗保健需求。 关于乡村医院如何协调医疗保健，人们知之甚少 提供急症后和长期护理服务提供者，如疗养院和 家庭健康机构。面对#年不断增长的医疗保健需求 在经济上充满敌意和不确定的环境下，乡村医院 多元化，通过“摇摆”提供急症后和长期护理 医院还与LTC建立了正式关系 供应商通过一种名为“垂直整合”的策略，其中 医院在以下情况下将急症后和LTC患者转移到LTC设施 正式或非正式的协议。 之前的研究表明，在农村地区，医院和LTC之间的联系 都很难确定。然而，正是这些联系可能是 为长者提供具成本效益和优质的医疗服务 居住在农村地区的残疾人。 该应用程序继续关注乡村医院之间的联系 和LTC提供商。拟议研究的明确目标是 四个方面：1)编制关于联系程度的描述性数据 乡村医院和长期护理服务提供者之间的联系以及联系的广度 类型发生在急性和LTC提供者之间；2)检查 年急性和LTC提供商之间的联动发展过程 与“摇摆床”项目参与的关系；3)检验假设 关于使用资源依赖的链接结构的决定因素 理论和制度理论；例如，假设 乡村医院经历了高成本水平、高成本差异 低水平、低医疗保险利润率、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 提供者；以及4)检验关于制度的假设 链接结构对层次的后果和(A)中的变化 每次入院的平均医疗保险住院成本和收入；和(B) 住院护理模式(例如，住院时间、接受的服务、 出院目的地)；假设乡村医院有更多 与LTC提供商的正式链接将体验到更低的成本和更小的规模 与非正式联系或没有联系的那些相比，成本差异更大。

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.