RESOURCE USE AND PATIENT OUTCOMES IN MEDICARE HOME CARE

医疗保险认证的家庭护理机构面临越来越大的压力， 提高患者的资源效率和护理质量， 都是由医疗保险计划承保的。 家庭护理机构的临床医生和 管理人员，主要是护士，正在通过收集和 审查标准化数据，以监测资源使用和患者 成果。 然而，几乎没有科学知识可以解释 医疗保险家庭护理患者的结果如何与 期间分配给这些患者的临床人员资源数量 家庭护理 因此，本研究的长期目标 是为了提高我们对 医疗保险家庭护理患者的资源使用和健康相关结局 有着不同特征的人， Medicare认证的家庭护理机构。 本研究的主要目的 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，市场控制，家庭 护理机构和患者变量。第二个目的是确定 市场因素的相对重要性，代理特征， 患者特征和家庭护理资源的使用影响家庭 护理患者的结果。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 作为病人谁结束了一段时间的照顾和留在家里，但他们将 表现出更大的服务强度，控制市场，代理， 患者变量 假设2：功能下降的患者 家庭护理期间的状态将使用相同数量的家庭 护理资源，如功能状态改善的患者， 市场、代理和患者变量。 假设3：患者 在家庭护理期间症状恶化将使用相同的量 家庭护理资源的患者的症状改善，控制 市场、代理和患者变量。假设4：观察到的 市场因素之间的关系（直接和间接影响）， 机构特性、居家照护资源使用与居家照护病患 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1，500名患者 来自30个随机选择的俄亥俄州家庭护理机构。患者数据将 由经过培训的家庭护理人员根据第一次评估收集， 和最后的访问。关于资源使用的信息， 家访亦会记录。 数据分析将决定 资源使用计量之间未经调整和经调整的关系 和患者结局。 项目咨询委员会将帮助翻译 规划家庭护理资源分配战略的调查结果 根据患者的结果。

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.