Role of Long-Term Acute Care Hospitals

项目摘要/摘要 GEMSSTAR R03奖将确立Anil Makam博士作为专注于影响的临床医生-研究员的地位 关于急性后护理对老年人急性疾病后健康结局的影响。这个R03奖将为他提供 在3个重点领域发展专门知识所需的支助：(1)急性后护理方面的老年临床培训；(2) 使用医疗保险数据的卫生服务研究(HSR)；以及(3)比较中的高级统计方法 有效性研究(CER)。为了实现这些目标，马卡姆博士召集了一位多学科的专家 在高铁、CER、老年病、康复和急性后护理方面的团队。他的主要导师伊森·哈姆博士 在高铁、CER和指导初级教员成为独立调查人员方面拥有丰富的经验。他的 科学顾问包括吉姆·古德温博士，他是使用医疗保险数据进行老龄化研究的领先专家，以及 高级生物静力学专家张松博士说。Makam博士还将受益于2个 老年医学(Rubin)和急性后护理(Muldoon)方面的知名临床顾问。 老年人对急性后护理的使用率正在上升，占#年地理差异的73%。 医疗保险支出。长期急性护理医院(LTAC)是急诊后增长最快的部分 关心。尽管有这种增长和变异，但人们对住院的老年人为什么会出院知之甚少 LTAC与在急性护理医院(ACH)接受持续护理的对比，以及哪种环境将优化他们的 恢复。根据他作为一名医院医生的临床经验和他的初步数据，马卡姆博士将进行 一系列全国性的研究来回答这些基本问题。他将使用国家医疗保险数据来识别 患者、医院和区域层面与LTAC使用相关的因素(与ACH相比)，并量化 每个级别的变化(目标1)。比较评估长期护理和持续护理的有效性。 作为一个关于结果、利用率、成本和支出的ACH，Makam博士将使用倾向评分和工具性 控制已测量和未测量差异的变量分析在选择哪种较老的 成人被送往LTAC(目标2)。这项研究计划利用了现有的机构资源， 包括UTSW CTSA和Halm博士的AHRQ资助的以患者为中心的结果研究中心，AS 以及古德温博士由NIA资助的老年病和康复结果研究小组。最后，这次培训 研究将补充他的K23提案，比较LTAC和熟练的护理设施，校长 急诊后护理候补。加在一起，他的R03和K23提案将通知随后的R01申请 进一步研究LTAC与替代护理方案的比较有效性及其相关的长期护理方案 功能和认知结果。这一建议和后续研究将直接为实践和 通过建立证据基础来帮助患者、提供者和付款人在急性事件后做出明智选择的政策 关心。

PROJECT SUMMARY/ABSTRACT This GEMSSTAR R03 award will establish Dr. Anil Makam as a clinician-investigator focused on the impact of post-acute care on health outcomes after acute illness in the elderly. This R03 award will provide him the support needed to develop expertise in 3 focused areas: (1) geriatric clinical training in post-acute care; (2) health services research (HSR) using Medicare data; and (3) advanced statistical methods in comparative effectiveness research (CER). To achieve these goals, Dr. Makam has assembled an expert multidisciplinary team in HSR, CER, geriatrics, rehabilitation, and post-acute care. His primary mentor, Dr. Ethan Halm, has extensive experience in HSR, CER and mentoring junior faculty to become independent investigators. His scientific advisors include Dr. Jim Goodwin, a leading expert in using Medicare data for aging research, and Dr. Song Zhang, an expert in advanced biostatics. Dr. Makam will also benefit from the expertise of 2 renowned clinical advisors in geriatrics (Rubin) and post-acute care (Muldoon). The use of post-acute care among the elderly is rising, and accounts for 73% of the geographic variation in Medicare spending. Long-term acute care hospitals (LTACs) are the fastest growing segment of post-acute care. Despite this growth and variation, little is known about why hospitalized older adults are discharged to LTACs versus receiving continued care in the acute care hospital (ACH), and which setting will optimize their recovery. Informed by his clinical experience as a hospitalist and his preliminary data, Dr. Makam will conduct a series of national studies to answer these essential questions. He will use national Medicare data to identify patient, hospital, and regional-level factors associated with LTAC use (vs. ACH) and quantify the degree of variation at each level (Aim 1). To comparatively assess the effectiveness of LTACs versus continued care in an ACH on outcomes, utilization, costs, and spending, Dr. Makam will use propensity score and instrumental variable analyses to control for both measured and unmeasured differences in the selection of which older adults are discharged to a LTAC (Aim 2). This research plan leverages existing institutional resources, including the UTSW CTSA and Dr. Halm’s AHRQ-funded Center for Patient-Centered Outcomes Research, as well as Dr. Goodwin’s NIA-funded geriatric and rehabilitation outcomes research group. Finally, this training and research will complement his K23 proposal comparing LTACs versus skilled nursing facilities, the principal post-acute care alternate. Together, his R03 and K23 proposals will inform a subsequent R01 application to further study the comparative effectiveness of LTACs vs. alternate care options and their associated long-term functional and cognitive outcomes. This proposal and the subsequent research will directly inform practice and policy by building the evidence base to assist patients, providers, and payers to ‘choose wisely’ in post-acute care.