The Changing Landscape of Post-Acute Care and Health Outcomes for Older Adults
老年人急性后护理和健康结果的变化
基本信息
- 批准号:9895614
- 负责人:
- 金额:$ 18.34万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2018
- 资助国家:美国
- 起止时间:2018-04-01 至 2023-03-31
- 项目状态:已结题
- 来源:
- 关键词:AddressAdmission activityAdultAffectAgeAge-YearsAgingAreaAutomobile DrivingCaringCase SeriesCase StudyClinicalCommunitiesComprehensive Health CareDataDevelopmentElderlyFacultyFractureFutureGeriatricsGoalsHealthHealth PolicyHealth Services ResearchHealth systemHeterogeneityHip FracturesHome environmentHospitalistsHospitalizationHospitalsIncentivesInpatientsInterviewK-Series Research Career ProgramsLiteratureMeasuresMedicalMedicareMentored Patient-Oriented Research Career Development AwardMentorsMentorshipMethodsModelingNatural experimentOutcomePatientsPatternPhysiciansPoliciesPrimary Care PhysicianPrivatizationProviderPublic Health SchoolsQualitative MethodsQualitative ResearchQuality of CareRandomizedReplacement ArthroplastyResearchResearch PersonnelReview LiteratureSafetySamplingSavingsSelection BiasSiteSubgroupSurveysTechniquesTimeTrainingVariantWomanWorkacute careadverse outcomebasebundled paymentcare deliverycare fragmentationcare providerscareercomparativedesignexperiencefaculty mentorfallsfinancial incentivefunctional statushealth care qualityhealth managementhigh riskhospital readmissionimprovedimproved outcomeinsightinstrumentlarge datasetsmultidisciplinaryolder patientpaymentprofessorpublic health insuranceresponseskillsstatisticswasting
项目摘要
PROJECT SUMMARY
This career development award for Dr. Michael L. Barnett, a primary care physician at Brigham and
Women’s Hospital and an assistant professor of health policy and management at the Harvard T.H. School of
Public Health, will establish Dr. Barnett as a clinician investigator with expertise on improving the quality and
value of care for older adults. This proposal builds on Dr. Barnett’s promising early career researching quality
and fragmentation of care delivery and focuses on an increasingly important and understudied domain of
fragmented care delivery for older adults: post-acute care (PAC). This K23 award will enable Dr. Barnett to
pursue this research area and grow into an independent investigator through support for three training goals:
1) Acquiring skills in advanced quantitative methods for causal inference in large datasets, 2) Developing
expertise in PAC for older patients, and 3) Acquiring skills in qualitative research and survey design. Dr.
Barnett will pursue these training goals guided by a multidisciplinary faculty team led by primary mentor Dr.
Arnold Epstein, an experienced junior faculty mentor with experience performing high-impact research in
health care quality and health policy. Dr. Barnett’s co-mentors are Dr. David Grabowski, an expert in post-
acute care policy and aging research and Dr. Ateev Mehrotra, who has expertise in episode-based payments
and health services research. Dr. Barnett will also partner with distinguished scientific consultants to provide
training and mentorship in statistics, geriatrics and qualitative methods.
Use of PAC for older adults is growing rapidly, but little is known about whether PAC improves health
outcomes for hospitalized older adults. New payment models, such as bundled payments, are increasingly
driving providers to lower PAC use, but the potential health impact of this change is unknown. Dr. Barnett will
examine the changing landscape of PAC with three integrated aims: first, Dr. Barnett will use Medicare
administrative claims to examine the relationship between low rates of PAC use and health outcomes
exploiting quasi-random assignment of patients to hospitalist physicians (Aim 1). Next, he will measure the
impact on PAC use and health outcomes of a national bundled payment model for total lower joint replacement
among high-risk vulnerable older adults who may be negatively impacted by lower PAC use (Aim 2). Finally, he
will conduct a comparative series of case studies of hospitals with contrasting changes in PAC use after
bundled payment implementation to identify practices associated with adapting to a new payment model (Aim
3). This research can directly inform current policy and payment reform for older adults to enhance the safe
and effective use of PAC. Results from this work will form the basis of an R01 proposal to study the
relationship between hospital-PAC integration and quality of care for hospitalized older adults.
项目总结
这一职业发展奖颁发给布里格姆大学的初级保健医生迈克尔·L·巴尼特博士
和哈佛T.H.学院卫生政策和管理学助理教授。
公共卫生,将使巴尼特博士成为临床医生研究员,具有提高质量和
照顾老年人的价值。这项建议建立在巴尼特博士充满希望的早期职业研究质量的基础上
和提供护理服务的碎片化,并侧重于一个日益重要但研究不足的领域
为老年人提供零散的护理服务:急性后护理(PAC)。这项K23奖项将使巴尼特博士能够
通过支持三个培训目标,从事这一研究领域并成长为一名独立的调查员:
1)掌握在大数据集上进行因果推理的高级定量方法的技能,2)开发
在老年患者的PAC方面的专业知识,以及3)获得定性研究和调查设计的技能。Dr。
巴尼特将在主要导师Dr。
阿诺德·爱泼斯坦,一位经验丰富的初级教员导师,在
卫生保健质量和卫生政策。巴尼特博士的共同导师是大卫·格拉博夫斯基博士,他是一位后医学专家
急性护理政策和老龄化研究以及Ateev Mehrotra博士,他在按时段支付方面拥有专业知识
和健康服务研究。巴尼特博士还将与杰出的科学顾问合作,为
在统计学、老年病学和定性方法方面的培训和指导。
老年人对PAC的使用正在迅速增长,但对PAC是否能改善健康知之甚少
住院老年人的结果。新的支付模式,如捆绑支付,正在日益增多
推动供应商降低PAC的使用,但这一变化对健康的潜在影响尚不清楚。巴尼特医生会
带着三个综合目标审视PAC不断变化的格局:第一,巴尼特博士将使用联邦医疗保险
检查低PAC使用率与健康结果之间关系的行政主张
利用准随机将病人分配给住院医生(目标1)。接下来,他将测量
全下关节置换国家捆绑支付模式对PAC使用和健康结局的影响
对于高危、脆弱的老年人,他们可能会受到较低的PAC使用量的负面影响(目标2)。最后,他
将进行一系列对比案例研究,以对比医院在PAC使用方面的对比变化
捆绑支付实施,以确定与适应新支付模式(AIM)相关的实践
3)。这项研究可以直接为当前老年人政策和支付改革提供参考,以增强老年人的安全感
和有效利用政治行动委员会。这项工作的结果将成为R01提案的基础,以研究
住院老年人医院-PAC一体化与护理质量的关系。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Michael Lawrence Barnett其他文献
Spread of Pathogens in the Patient Transfer Network of US Hospitals
美国医院患者转运网络中病原体传播
- DOI:
- 发表时间:
2015 - 期刊:
- 影响因子:0
- 作者:
J. Fernández;J. Onnela;Michael Lawrence Barnett;V. Eguíluz;N. Christakis - 通讯作者:
N. Christakis
Business as usual? An exploration of the determinants of success in the multinational transfer of corporate responsibility initiatives
照常营业?
- DOI:
10.1515/bap-2012-0019 - 发表时间:
2012 - 期刊:
- 影响因子:1.8
- 作者:
Michael Lawrence Barnett;Sunyoung Lee - 通讯作者:
Sunyoung Lee
Taking Stock of Care Delivery Transformation.
评估护理服务转型。
- DOI:
- 发表时间:
2023 - 期刊:
- 影响因子:0
- 作者:
S. Gondi;Michael Lawrence Barnett - 通讯作者:
Michael Lawrence Barnett
Care delivery approaches and perceived barriers to improving quality of care: A national survey of skilled nursing facilities
护理提供方法和提高护理质量的障碍:对熟练护理设施的全国调查
- DOI:
- 发表时间:
2023 - 期刊:
- 影响因子:6.3
- 作者:
Amanda C Chen;A. Epstein;Karen E. Joynt Maddox;D. Grabowski;E. Orav;Michael Lawrence Barnett - 通讯作者:
Michael Lawrence Barnett
The "medical neighborhood": integrating primary and specialty care for ambulatory patients.
“医疗社区”:整合门诊患者的初级和专科护理。
- DOI:
10.1001/jamainternmed.2013.14093 - 发表时间:
2014 - 期刊:
- 影响因子:39
- 作者:
J. Greenberg;Michael Lawrence Barnett;M. Spinks;J. Dudley;J. Frolkis - 通讯作者:
J. Frolkis
Michael Lawrence Barnett的其他文献
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{{ truncateString('Michael Lawrence Barnett', 18)}}的其他基金
The Use of Telemedicine in the Care of Nursing Home Residents with Alzheimer's Disease and Related Dementias During and After the COVID-19 Pandemic
在 COVID-19 大流行期间和之后使用远程医疗来护理患有阿尔茨海默病和相关痴呆症的疗养院居民
- 批准号:
10594541 - 财政年份:2022
- 资助金额:
$ 18.34万 - 项目类别:
Physician Subspecialization and the Health and Health Care of Older Americans
医生亚专业化与美国老年人的健康和保健
- 批准号:
10708114 - 财政年份:2022
- 资助金额:
$ 18.34万 - 项目类别:
Physician Subspecialization and the Health and Health Care of Older Americans
医生亚专业化与美国老年人的健康和保健
- 批准号:
10584875 - 财政年份:2022
- 资助金额:
$ 18.34万 - 项目类别:
The Use of Telemedicine in the Care of Nursing Home Residents with Alzheimer's Disease and Related Dementias During and After the COVID-19 Pandemic
在 COVID-19 大流行期间和之后使用远程医疗来护理患有阿尔茨海默病和相关痴呆症的疗养院居民
- 批准号:
10345587 - 财政年份:2022
- 资助金额:
$ 18.34万 - 项目类别:
The Changing Landscape of Post-Acute Care and Health Outcomes for Older Adults
老年人急性后护理和健康结果的变化
- 批准号:
10370357 - 财政年份:2018
- 资助金额:
$ 18.34万 - 项目类别:
Improving Specialty Care Delivery in the Safety Net with Natural Language Processing
通过自然语言处理改善安全网中的专业护理服务
- 批准号:
9789060 - 财政年份:2018
- 资助金额:
$ 18.34万 - 项目类别:
The Changing Landscape of Post-Acute Care and Health Outcomes for Older Adults
老年人急性后护理和健康结果的变化
- 批准号:
10253539 - 财政年份:2018
- 资助金额:
$ 18.34万 - 项目类别: