STATE POLICIES AND HEALTH SYSTEMS FACTORS ASSOCIATED WITH MULTIPLE TRANSITIONS

医疗服务的中断是美国医疗保健系统内的一个主要问题。通过财政奖励和 法规、联邦和州政策可能会影响不同护理水平的过渡数量和模式。 失去亲人的家庭报告称，虚弱、年长的人多次转变与医疗差错有关 信息不连续和功能衰退。虽然研究证明了惊人的 在卫生保健利用的地理差异方面，很少有人记录卫生保健过渡的差异。 合并全国医疗保险索赔数据和最小数据集，这项研究将描述 四组老年人的护理过渡：1)长期入住疗养院(NH)居民，中等至 严重的认知障碍；2)死者；3)髋部骨折手术后的老年人；以及4) 75岁及以上的患者因晚期结直肠癌从急诊医院出院。目标1描述 过渡的模式和比率，侧重于七年期间的地理变化，1999年至 2006年。目标2检查与较高的护理转换率和 复杂的多站点过渡，以及状态策略的变化是否与 转换的速率。AIM 3检查患者的结果(例如，功能衰退、丧亲家庭成员 对临终关怀质量的看法)在不同比率和护理模式的地理区域 过渡。目标4将既是验证性的，也是探索性的；确定护理主任和NH主任 管理者对制度政策的态度、认知和报告证实了当地的做法，即。 转换率。此外，这一目标将探索国家政策如何影响过渡。从这里学到的知识 研究将指导有关护理过渡和改善对体弱、老年人护理的协调的公共政策 美国人。 世俗摘要：虚弱的老年人经常经历医疗保健环境的变化(即，医疗保健 过渡)。这项研究将考察美国各地的医疗过渡比率和类型是如何变化的 以及国家政策和当地医疗保健市场的特点如何影响这种转变。

Discontinuity of care is a major concern within the US Health Care System. Through financial incentives and regulations, federal and state policies may affect the number and patternof transitions across levels of care. Multiple transitions of frail, older persons have been associatedwith medical errors, bereaved family reports of information discontinuity, and functional decline. While research studies have documented striking geographic variation in health care utilization, few have documented the variation in health care transitions. Merging national Medicare Claims Data and the Minimum Data Set, this research will describe variation in care transitions for four cohorts of older adults: 1) long stay nursing home (NH) residents with moderate to severe cognitive impairment; 2) decedents ; 3) older persons following hip fracture surgery; and 4) persons age 75 and older discharged from an acute care hospital with advanced colorectal cancer. Aim 1 describes patterns and rates of transitions with a focus on geographic variation over a seven year period, 1999 to 2006. Aim 2 examines health system and state factors associated with higher rates of care transitions and complicated, multi-site transitions, and whether changes in state polices are associated with changes in the rate of transitions. Aim 3 examines patient outcomes (e.g. functional decline, bereaved family member perceptions of the quality of end of life care) in geographic regions with varying rates and patterns of care transitions. Aim 4 will be both confirmatory and exploratory; determines whether directors of nursing and NH administrators' attitudes, perceptions, and reports of institutional policies confirm the local practice viz. transition rates. Additionally, this aim willl explore how state policies effect transitions. Knowledge from this research will guide public policy regarding care transitions and improved coordination of care for frail, older Americans. Lay Summary: Frail, older persons often experience changes in settings of health care (i.e., a health care transition). This research will examine how the rates and type of health care transitions vary across the US and how state policies and characterisitics of the local health care market affect such transitions.