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

疗养院与临终关怀合作的特点

• 批准号: 8582937
• 负责人: Shubing Cai
• 金额: $ 9.12万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8582937
• 关键词: Accounting; Address; Advocate; Aging; Caring; Cessation of life; Characteristics; Collaborations; Conflict (Psychology); Contracts; Costs and Benefits; Country; Data; Data Set; Exposure to; Goals; Growth; Health; High Prevalence; Hospice Care; Hospitalization; Individual; Knowledge; Lead; Life; Marketing; Medicare; Mission; National Institute on Aging; Nursing Homes; Outcome; Palliative Care; Pattern; Philosophy; Policies; Policy Maker; Provider; Public Health; Quality of life; Research; Testing; Variant; care delivery; cost; end of life; geographic difference; hospice environment; improved; innovation; public health relevance; rapid growth; trend

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.

描述（由申请人提供）：垂死的疗养院（NH）居民经常在生命的最后30天内住院，导致健康状况恶化和医疗保险费用高昂。虽然已经表明，临终关怀的使用导致临终关怀登记者的住院率较低，目前还不清楚NH-临终关怀合作的属性-特别是临终关怀的使用量和合作的排他性（即NH是否主要与一个或两个或更多提供者合作）-与所有NH死亡居民的住院相关（NH-临终关怀合作也可能通过溢出效应使非临终关怀居民受益）。临终关怀提供者在NH市场的快速增长和这种增长的巨大地理差异为我们提供了一个机会，研究不断变化的属性NH临终关怀合作和临终（EOL）住院之间的关系。长期目标是了解可用于改善临终患者姑息治疗并降低成本的方法。本研究的目的是了解NH-临终关怀合作的具体属性如何与NH的EOL住院相关。其基本原理是，这项研究将铺平道路，进一步深入研究之间的因果关系的NH临终关怀合作和EOL住院，并最终提供指导，更好地临终关怀姑息治疗提供给所有垂死的NH居民。根据2000-2009年的国家数据，本研究有两个目的。目的-1是通过在ALL NH死者中检验以下2个假设来检查NH-临终关怀合作属性与EOL住院之间的关系。(1)如果居住在临终关怀使用量较高的NH，居民在死亡前30天内住院的可能性较小，说明NH-临终关怀合作的排他性水平;（2）如果居住在与NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-NH-N 临终关怀提供者，占临终关怀使用量。目的-2是探讨目的-1中确定的关系是否因临终关怀提供者的增长率不同而异。这项研究是创新的，因为它是第一个研究NH临终关怀合作的排他性和EOL住院之间的关系，它扩展了现有的研究，通过检查所有NH临终居民而不仅仅是临终关怀登记者使用临终关怀的影响。它还利用纵向数据和临终关怀提供者增长率的地理差异，以最大限度地减少NH临终关怀合作与EOL住院之间估计关系的潜在偏差。这项研究意义重大，因为它将增加我们对NH-临终关怀合作如何改善护理的理解，特别是对所有垂死的NH居民的EOL住院治疗。这些发现对于政策制定者评估临终关怀使用的成本和效益以及NH提供者做出与临终关怀合作的明智决策都很重要。最终，减少EOL住院不仅可以提高垂死居民的生活质量，还可以节省医疗保险费用。