Attributes of nursing home-hospice collaborations & end of life hospitalizations

描述（由申请人提供）：临终的养老院（NH）居民经常在他们生命的最后30天内住院，导致更差的健康结果和更高的医疗保险费用。虽然已有研究显示安宁疗护的使用会降低安宁疗护参保者的住院率，但目前尚不清楚安宁疗护合作的属性──特别是安宁疗护的使用数量和合作的排他性（例如，一个安宁疗护机构主要是与一个或两个以上的提供者合作）──与所有安宁疗护临终居民的住院率有何关联（安宁疗护合作也可能透过溢出效应使非安宁疗护居民受益）。安宁疗护提供者在NH市场的快速成长，以及这种成长的巨大地理差异，提供我们一个机会，来研究NH安宁疗护合作与生命末期（EOL）住院之间的关系。长期目标是了解可用于改善临终病人的姑息治疗和降低成本的方法。本研究的目的是了解NH安宁疗护合作的特定属性如何与NH的EOL住院有关。本研究旨在为进一步深入研究NH安宁疗护合作与EOL住院之间的因果关系铺平道路，并最终为所有临终的NH居民提供更好的安宁疗护姑息治疗提供指导。使用2000-2009年的国家数据，这项研究有两个目的。目的-1通过检验所有NH死者的以下两个假设，来检验NH安宁疗护合作属性与EOL住院之间的关系。(1)考虑到医院与安宁疗护合作的排他性，居住在安宁疗护使用率较高的医院的居民在死亡前30天住院的可能性较低；(2)如果居民居住在与某人有排他性关系的NH，则可能在死亡前30天住院

DESCRIPTION (provided by applicant): Dying nursing home (NH) residents are frequently hospitalized within the last 30 days of their lives, resulting in worse health outcomes and high Medicare costs. While it has been shown that hospice use leads to lower hospitalization rates among hospice enrollees, it is unclear how the attributes of NH-hospice collaborations - specifically the volume of hospice use and exclusivity of the collaboration (i.e. whether a NH primarily collaborates with one versus two or more providers) - are associated with hospitalizations among all NH dying residents (NH-hospice collaborations may also benefit non-hospice residents through spill-over effects). The rapid growth of hospice providers in NH markets and substantial geographic variations in such growth provide us with an opportunity to study the relationship between changing attributes of NH-hospice collaborations and end-of-life (EOL) hospitalizations. The long-term goal is to understand the approaches that can be used to improve palliative care for dying residents and to reduce costs. The objective of this study is to understand how specific attributes of NH-hospice collaborations are associated with EOL hospitalizations in NH. The rationale is that this study will pave the way for further in-depth studies of the causal relationship between NH-hospice collaborations and EOL hospitalizations, and ultimately provide guidance for better hospice palliative care delivery to all dying NH residents. Using national data from 2000-2009, this study has two aims. Aim-1 is to examine the relationship between attributes of NH-hospice collaborations and EOL hospitalizations by testing the following 2 hypotheses among ALL NH decedents. (1) A resident is less likely to be hospitalized in the 30 days before death if residing in a NH with a higher volume of hospice use, accounting for the level of exclusivity of NH-hospice collaborations; and (2) A resident is likely o be hospitalized in the 30 days before death if residing in a NH with an exclusive relationship with a hospice provider, accounting for the volume of hospice use. Aim-2 is to explore whether the relationship identified in Aim-1 varies across states with different growth rates of hospice providers. This study is innovative because it is the first study to examine the relationship between exclusivity of NH-hospice collaborations and EOL hospitalizations, and it extends existing research by examining the effect of hospice use among all NH dying residents rather than only hospice enrollees. It also takes advantage of both longitudinal data and the geographic variations in the growth rates of hospice providers to minimize the potential bias in the estimated relationship between NH-hospice collaborations and EOL hospitalizations. This study is significant because it will add to our understanding of how NH-hospice collaborations can improve care, specifically EOL hospitalizations, for all dying NH residents. The findings will be important both for policymakers to evaluate the costs and benefits of hospice use, and for NH providers to make informed decisions about collaborating with hospices. Ultimately, reducing EOL hospitalizations will not only improve the quality of life for dying residents, but alo save Medicare costs.