Role of Long-Term Acute Care Hospitals

项目总结/摘要 这个GEMSSTAR R 03奖将建立博士Anil Makam作为一个临床研究者专注于影响 急性病后护理对老年人急性病后健康结果的影响。这个R 03奖将为他提供 需要提供支助，以发展3个重点领域的专门知识：（1）急性期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）;（3）比较先进的统计方法 有效性研究（CER）。为了实现这些目标，Makam博士召集了一位多学科专家， HSR、CER、老年病、康复和急性期后护理团队。他的主要导师伊森·哈尔姆博士 在HSR，CER和指导初级教师成为独立调查员方面拥有丰富的经验。他 科学顾问包括Jim Goodwin博士，他是使用医疗保险数据进行老龄化研究的领先专家， 博士宋章，高级生物静力学专家。Makam博士还将受益于2 著名的老年医学（鲁宾）和急性后护理（马尔登）临床顾问。 老年人使用急性后护理的情况正在增加，占老年人使用急性后护理的地理差异的73%。 医疗支出。长期急性护理医院（LTAC）是急性期后患者中增长最快的部分。 在乎尽管这种增长和变化，很少有人知道为什么住院的老年人出院到 LTAC与在急性护理医院（ACH）接受持续护理的比较，以及哪种设置将优化其 复苏根据他作为一名住院医生的临床经验和他的初步数据，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、医院和区域水平因素，并量化 每个层次的差异（目标1）。比较评估LTAC与持续护理在以下患者中的有效性： 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，以控制测量和未测量的差异，在选择哪些老年人 成年人出院到LTAC（目标2）。这项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， 以及古德温博士的国家情报局资助的老年和康复成果研究小组。最后，这次培训 研究将补充他的K23建议，将LTAC与熟练的护理设施进行比较， 急性期后交替护理。他的R 03和K23提案将一起通知随后的R 01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 功能和认知结果。这一建议和随后的研究将直接告知实践， 通过建立证据基础来帮助患者，提供者和支付者在急性后 在乎

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.