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CHANGING LONG-TERM CARE IN AMERICA: POLICIES, MARKETS, STRATEGIES AND OUTCOMES

改变美国的长期护理：政策、市场、战略和结果

基本信息

批准号：
8608175
负责人：
Vincent Mor
金额：
$ 135.65万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-15 至 2019-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8608175
关键词：
Acute Affect Aging Ambulatory Care Americas Caring Cataloging Catalogs Chicago Communities Custodial Care Data Disabled Persons Evolution Faculty Foundations Funding Future Gerontology Health Health Policy Health Services Research Health Services for the Aged Hospitalization Hospitals Incentives Information Systems Interest Group Investments Link Literature Long-Term Care Managed Care Marketing Medicaid Medical Medicare Medicare/Medicaid Nursing Homes Outcome Paper Patients Physician&apos s Role Policies Policy Maker Population Professional Organizations Program Research Project Grants Provider Publishing Regulation Research Research Infrastructure Research Personnel Research Project Grants Role Services Structure United States National Institutes of Health Universities Update Work base beneficiary comparative cost effective design experience interest news programs repository response symposium time use web site

项目摘要

DESCRIPTION (provided by applicant): A key policy question for the coming decade is how best to structure incentives and regulations to insure that frail older hospitalized patients receie cost effective and coordinated care. Both federal and state policy has transformed long-term care with the emergence of post-acute care provided by nursing homes (NH) and other providers. Post-acute care now represents approximately 20% of all Medicare spending. Our first Program Project grant focused on the effect of states' Medicaid policies on the strategic choices that NHs make and how those choices impact patient outcomes. We find that not only do states' policies influence providers' investments which can positively or adversely affect residents' outcome, we've also found that Medicare policies affected Medicaid providers and states' Medicaid policies affected Medicare patients, often in a dysfunctional manner. Indeed, Medicare policy changes directed at acute hospitals "trickle down" to impact most NHs further highlighting the interconnectedness of long term and post-acute care policy domains. Thus, Medicaid and Medicare policies are intertwined; when Medicare policies change, even if only directed at hospitals, NHs and other PAC providers are affected. Since the Affordable Care Act (ACA) represents the biggest policy change to Medicare and Medicaid in decades, we believe it is imperative to understand its effects on the acute care and post-acute care interface. The three projects and cores we propose all focus on the growing role of post-acute care (PAC); each has historical aims as well as aims that examine the impact of the Affordable Care Act (ACA). Project #1 asks whether hospitals with strong relationships with NH partners have lower re-hospitalization rates. Project #2 examines the impact of hospitals' approaches to staffing the attending physician role on frail, hospitalized NH residents experience. Finally, Project #3 examines, for the first time, the use of PAC by Medicare managed care and how patients respond to changing co-pay structures for PAC.

描述（由申请人提供）：未来十年的一个关键政策问题是如何最好地制定激励措施和法规，以确保体弱的老年住院患者获得具有成本效益和协调一致的护理。随着疗养院 (NH) 和其他提供者提供的急性后期护理的出现，联邦和州政策都改变了长期护理。目前，急性后期护理约占所有医疗保险支出的 20%。我们的第一个计划项目拨款重点关注各州医疗补助政策对 NH 做出的战略选择的影响以及这些选择如何影响患者的治疗结果。我们发现，州的政策不仅会影响提供者的投资，从而对居民的结果产生积极或不利的影响，我们还发现医疗保险政策影响医疗补助提供者，而州的医疗补助政策通常以功能失调的方式影响医疗保险患者。事实上，针对急性医院的医疗保险政策变化会“渗透”到大多数NH医院，进一步凸显了长期和急性后护理政策领域的相互关联性。因此，医疗补助和医疗保险政策是相互交织的；当医疗保险政策发生变化时，即使仅针对医院、NH 和其他 PAC 提供者也会受到影响。由于《平价医疗法案》(ACA) 代表了数十年来对医疗保险和医疗补助的最大政策变化，我们认为有必要了解其对急症护理和急症后护理界面的影响。我们提出的三个项目和核心都关注急性后护理（PAC）日益增长的作用；每个项目都有历史目标以及检验《平价医疗法案》(ACA) 影响的目标。项目#1 询问与 NH 合作伙伴关系密切的医院是否具有较低的再住院率。项目#2 研究了医院配备主治医师角色的方法对虚弱的新罕布什尔州住院患者体验的影响。最后，项目#3 首次研究了 Medicare 管理式护理对 PAC 的使用情况，以及患者如何应对不断变化的 PAC 共同支付结构。