RESOURCE USE AND PATIENT OUTCOMES IN MEDICARE HOME CARE

经过联邦医疗保险认证的家庭护理机构面临着越来越大的压力 提高以下患者的资源效率和护理质量 都是由医疗保险计划投保的。家庭护理机构临床医生和 管理者，主要是护士，正在通过收集和 审查标准化数据以监控资源使用情况和患者 结果。然而，几乎没有科学知识来解释 医疗保险家庭护理患者的结果如何与 年内分配给这些病人的临床人力资源量 家庭护理插曲。因此，这项研究的长期目标是 是为了提高我们对两者复杂相互作用的理解 医疗保险家庭护理患者的资源使用和健康相关结果 具有不同的特征，由不同的 医疗保险认证的家庭护理机构。这项研究的主要目的是 是确定家庭护理患者的结果如何与 具体的家庭护理资源使用措施，控制市场，家庭 护理机构和患者变量。次要目标是确定 市场因素的相对重要性，中介机构的特点， 患者特征和家庭护理资源使用对家庭的影响 关心病人的结果。假设1：结束一段护理的患者 由于住院将使用相同数量的家庭护理资源 作为结束一段时间的护理并留在家里的患者，但他们会 展示更大的服务强度，控制市场、代理和 病人的变数。假设2：功能衰退的患者 在一次家庭护理期间的状态将使用相同数量的家庭 作为改善功能状态的患者的护理资源，控制 针对市场、机构和患者变量。假设3：患者的 在家庭护理的一次发作期间症状恶化将使用相同的量 作为症状改善、控制的患者的家庭护理资源 针对市场、机构和患者变量。假设4：观察到的 市场因素之间的关系(直接和间接影响)， 机构特征、家庭护理资源使用与家庭护理患者 结果将由结构方程模型充分表示。 采用前瞻性队列研究设计，我们将招募1500名患者 来自俄亥俄州随机挑选的30家家庭护理机构。患者数据将被 由训练有素的家庭护理人员根据最初的评估收集 和最后一集的访问。有关资源使用情况的信息 家访也将被记录下来。数据分析将确定 资源使用衡量标准之间未调整和已调整的关系 和病人的结果。一个项目咨询委员会将帮助翻译 规划居家护理资源分配策略的研究结果 根据患者的治疗结果。

Medicare-certified home care agencies are under increasing pressure to improve both resource efficiency and quality of care for patients who are insured by the Medicare program. Home care agency clinicians and managers, predominantly nurses, are responding by collecting and reviewing standardized data to monitor resource use and patient outcomes. Yet little scientific knowledge has been produced to explain how outcomes in Medicare home care patients are associated with the amount of clinical staff resources allocated for these patients during home care episodes. Therefore, the long-term objective of this study is to improve our understanding of the complex interplay between resource use and health-related outcomes in Medicare home care patients with diverse characteristics who are served by a diverse group of Medicare-certified home care agencies. The primary aim of this study is to determine how home care patient outcomes are associated with specific home care resource use measures, controlling for market, home care agency, and patient variables. The secondary aim is to determine the relative importance of market factors, agency characteristics, patient characteristics, and home care resource use in influencing home care patient outcomes. Hypothesis 1: Patients who end an episode of care due to hospitalization will use the same amount of home care resources as patients who end an episode of care and remain at home, but they will show greater service intensity, controlling for market, agency, and patient variables. Hypothesis 2: Patients who decline in functional status during an episode of home care will use the same amount of home care resources as patients who improve in functional status, controlling for market, agency, and patient variables. Hypothesis 3: Patients whose symptoms worsen during an episode of home care will use the same amount of home care resources as patients whose symptoms improve, controlling for market, agency, and patient variables. Hypothesis 4: The observed relationships (direct and indirect effects) between market factors, agency characteristics, home care resource use, and home care patient outcomes will be adequately represented by a structural equation model. Using a prospective cohort study design, we will enroll 1,500 patients from 30 randomly-selected Ohio home care agencies. Patient data will be collected by trained home care staff, based on assessments at the first and final visits of episodes. Information about resource use at every home visit will also be recorded. Data analyses will determine unadjusted and adjusted relationships between measures of resource use and patient outcomes. A Project Advisory Committee will help translate findings into strategies for planning home care resource allocation based on patient outcomes.