Role of Long-Term Acute Care Hospitals

长期急症护理医院的作用

• 批准号: 9326121
• 负责人: Ethan A Halm
• 金额: $ 12.15万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9326121
• 关键词: Acute; Admission activity; Adopted; Aging; Antibiotics; Area; Award; Caring; Clinical; Cognitive; Comparative Study; Complement; Complex; Data; Data Set; Effectiveness; Elderly; Electronic Health Record; Ensure; Explosion; Faculty; Funding; Geriatrics; Goals; Growth; Health; Health Services; Health Services Research; Home environment; Hospitalists; Hospitalization; Hospitals; Individual; Intensive Care Units; Intravenous; Lead; Length of Stay; Measures; Mechanical ventilation; Medical; Medicare; Medicare claim; Medicine; Mentors; Methods; Modeling; Outcome; Outcomes Research; Patients; Policies; Provider; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Research; Research Personnel; Resources; Role; Series; Services; Severities; Severity of illness; Site; Skilled Nursing Facilities; Source; Statistical Methods; Training; United States Agency for Healthcare Research and Quality; Variant; Work; beneficiary; care episode; career; comparative; comparative effectiveness; compare effectiveness; cost; design; effectiveness research; evidence base; experience; functional outcomes; geographic difference; health care service utilization; health data; high risk; hospital patient care; hospital utilization; improved outcome; mortality; multidisciplinary; multilevel analysis; older patient; patient oriented; payment; policy implication; prospective; training opportunity; wound

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.

项目概要/摘要 GEMSSTAR R03 奖项将使 Anil Makam 博士成为一名专注于影响的临床医生研究员 急性后护理对老年人急性疾病后健康结果的影响。这个 R03 奖项将为他提供 需要支持在 3 个重点领域发展专业知识：(1) 急性期后护理的老年临床培训； (2) 使用医疗保险数据进行健康服务研究 (HSR)； (3)先进的比较统计方法 有效性研究（CER）。为了实现这些目标，Makam 博士召集了多学科专家 HSR、CER、老年病学、康复和急性后护理团队。他的主要导师 Ethan Halm 博士 在 HSR、CER 以及指导初级教师成为独立研究者方面拥有丰富的经验。他的 科学顾问包括 Jim Goodwin 博士，他是利用医疗保险数据进行衰老研究的领先专家， 张松博士，高级生物静力学专家。 Makam 博士还将受益于 2 名专家的专业知识 老年病学 (Rubin) 和急性后期护理 (Muldoon) 领域的著名临床顾问。 老年人对急症后护理的使用正在增加，占老年人地域差异的 73% 医疗保险支出。长期急性护理医院 (LTAC) 是急性后护理中增长最快的部分 关心。尽管存在这种增长和变化，但我们对住院老年人出院的原因知之甚少。 LTAC 与在急症护理医院 (ACH) 接受持续护理相比，哪种环境可以优化他们 恢复。根据他作为住院医生的临床经验和初步数据，Makam 博士将进行 一系列国家研究来回答这些基本问题。他将使用国家医疗保险数据来确定 与 LTAC 使用（与 ACH）相关的患者、医院和地区因素，并量化使用 LTAC 的程度 每个级别的变化（目标 1）。比较评估 LTAC 与持续护理的有效性 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 变量分析，以控制在选择哪些较老的人时测量和未测量的差异 成人出院到 LTAC（目标 2）。该研究计划利用现有的机构资源， 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， 以及 Goodwin 博士的 NIA 资助的老年和康复结果研究小组。最后，本次培训 研究将补充他的 K23 提案，比较 LTAC 与熟练护理机构，校长 急性后护理替代。他的 R03 和 K23 提案将共同为后续的 R01 申请提供信息 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 功能和认知结果。该提案和后续研究将直接指导实践和 通过建立证据基础来协助患者、提供者和付款人在急性期后“做出明智选择” 关心。