Understanding Variations in Hip Fracture Outcomes across the Continuum of Care

描述(由申请人提供)：对于患有急性内科和外科疾病的老年人，在急性和急性后护理机构提供的护理的差异在多大程度上有助于目前的长期生存和功能恢复模式？这个问题对理解老年人的医疗保健和结果之间的关系是至关重要的，具有深刻的政策含义。拟议的提供制度改革，如负责任的护理组织和捆绑支付，侧重于治疗的最终结果，而不是在任何特定环境中提供的服务数量，以此作为确定保健支付的适当基础。因此，了解卫生保健系统的不同组成部分在多大程度上导致了患者结局的不同，对于有效地设计、实施和评估这些政策战略至关重要。我的项目将增加目前的知识，即美国医疗保健系统的两个不同组成部分-急性和急性后护理设施-提供的医疗服务的差异如何有助于观察到患有急性疾病的老年人的结局模式。为此，它将重点关注患有髋部骨折的老年人的护理和结果。髋部骨折是一种高度病态的疾病，每年影响超过30万美国老年人。它将采用混合方法，包括对髋部骨折患者的全国性回顾队列研究和对卫生保健提供者和管理者的一系列定性访谈：1)衡量特定的急性和急性后护理设施因素与髋部骨折后6个月存活期和功能恢复的关系~2)比较急性和急性后护理设施因素对髋部骨折后6个月存活率和功能恢复的相对影响~3) 描述各种急症和急症后护理机构对髋部骨折护理的机构方法的质的差异。通过这一研究过程，我的项目将为髋部骨折结果差异的程度和原因提供新的见解，并作为一个模型，了解影响老年人的广泛内科和手术条件下健康结果的系统性决定因素。除了有组织的指导和研究培训课程外，这个项目将为我提供所需的技能和经验，以实现我的职业目标，即成为一名致力于改善美国住院和手术老年人的护理系统和结果的领先老龄研究人员。

DESCRIPTION (provided by applicant): To what extent do variations in the care delivered at acute and post-acute care facilities contribute to current patterns of long-term survival and functional recovery for older adults with acute medical and surgical conditions? This question, which is fundamental to understanding the relationship between medical care and outcomes for older adults, carries profound policy implications. Proposed delivery-system reforms, such as accountable care organizations and bundled payments, focus on the end results of treatment, rather than the quantity of services provided in any given setting, as the proper basis for determining health care payments. As a result, knowing the extent to which discrete components of the health care system now contribute to variations in patient outcomes is vital to the effective design, implementation and evaluation of these policy strategies. My project will add to current knowledge as to how variations in the care delivered within two distinct components of the U.S. health care system-acute and post-acute care facilities-each contribute to observed patterns of outcomes among older adults with acute illnesses. To do so, it will focus on the care and outcomes of older adults with hip fracture, a highly morbid condition that affects over 300,000 older U.S. adults each year. Taking a mixed-methods approach, it will incorporate a national retrospective cohort study of hip fracture patients and a series of qualitative interviews with health care providers and administrators to: 1) measure the association of specific acute and post-acute care facility factors with 6-month survival and functional recovery after hip fracture~ 2) compare the relative influence of acute versus post-acute care facility factors on 6-month survival and functional recovery after hip fracture~ and 3) characterize qualitative differences in institutional approaches to hip fracture care across a range of acute and post-acute care facilities. Through this course of research, my project will offer new insights into the extent and causes of variations in hip fracture outcomes and serve as a model for understanding the systemic determinants of health outcomes across a broad range of medical and surgical conditions affecting older adults. Along with a structured course of mentoring and research training, this project will provide me with the skills and experiences needed to reach my career goal of becoming a leading researcher in aging dedicated to improving systems of care and outcomes for older adults undergoing hospitalization and surgery in the U.S.