权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

UNDERSTANDING THE ROLE OF PHYSICIAN INTEGRATION WITHIN NURSING HOMES IN POST-ACUTE CARE OUTCOMES

了解疗养院内医生整合对急性后护理结果的作用

基本信息

批准号：
9912079
负责人：
Kira L Ryskina
金额：
$ 16.42万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-04-01 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9912079
关键词：
Acute Admission activity Adopted Adult Affect Aging Back Caring Communication Communities Continuity of Patient Care Credentialing Data Data Set Databases Employment Goals Heterogeneity Home Nursing Care Hospitalists Hospitalization Hospitals Link Measures Medical Staff Medicare Part A Medicare Part B Medicare claim Mentorship Modeling Nurse&apos s Role Nursing Homes Outcome Patient Care Patient Readmission Patient-Focused Outcomes Patients Physician&apos s Role Physicians Policies Process Provider Research Research Personnel Sampling Surveys System Variant Work acute care bundled payment care coordination care delivery care episode care outcomes care providers cost hospital readmission improved improved outcome indexing inpatient service multiple chronic conditions nursing home length of stay payment public health relevance skills

项目摘要

DESCRIPTION (provided by applicant): Post-acute care in nursing homes (NHs) is common, costly, and variable in quality. While physicians are often seen as integral to improving care coordination and transitions in care, little is known about the role of physicians within NHs in th outcomes of patients who transition from hospitals to post-acute care at these facilities. Hospitals have increasingly adopted strategies to improve patient outcomes and reduce costs- concentrating inpatient care among fewer physicians who specialize in hospital care and using organizational strategies that provide more hands-on oversight of physicians. However, the effect of similar strategies in the NH setting is unknown. Additionally, because post-acute care NH patients tend to be older and sicker, concerns have been raised about whether reducing continuity of care with primary care providers will lead to more challenging transitions to the community for these patients. The current project will evaluate the degree to which NHs concentrate their patient care among a few versus many physicians, the degree to which a NH's physicians specialize in providing NH care, and the organizational strategies NHs use to manage physician relationships (such as employment or contractual arrangements, credentialing, or oversight) as potential mechanisms to improve the outcomes of patients receiving post-acute care in NHs. To accomplish this research, I will use an existing database of a nationally representative sample of NHs merged with institutional Part A Medicare claims, the nursing home Minimum Data Set, and survey data on NH physician organizational strategies, expanding this database to include all Medicare Part B claims for physicians in the sample to measure physician specialization within NHs. Working under the mentorship of experts in post-acute care policy and NH medical staff organization, I will: (1) measure the association between the degree to which HNs concentrate their patient care among a few versus many physicians and post-acute care outcomes (patient readmission to the hospital within 30-days of NH admission and successful discharge to the community); (2) measure the effect of physician specialization in NH care on these outcomes; and (3) measure the effect of NHs' organizational strategies for physicians on these outcomes. When complete, these studies will provide new key information regarding a modifiable aspect of the post-acute care delivery system to inform NH policy and practice. This work will also help me establish a set of skills to become an independent investigator evaluating the value of various physician practice models to optimize care delivery for aging patients with multiple chronic conditions.

描述（由申请人提供）：在疗养院（NH）的急性期后护理是常见的，昂贵的，质量可变。虽然医生通常被视为改善护理协调和护理过渡的不可或缺的一部分，但对于从医院过渡到这些设施的急性期后护理的患者的结局，NHS内医生的作用知之甚少。医院越来越多地采用改善患者预后和降低成本的策略-将住院护理集中在少数专门从事医院护理的医生中，并使用组织策略，为医生提供更多的实际监督。然而，在NH设置类似的策略的效果是未知的。此外，由于急性护理后NH患者往往年龄较大，病情较重，因此人们担心减少与初级保健提供者的护理连续性是否会导致这些患者向社区过渡更具挑战性。目前的项目将评估在何种程度上NHS集中他们的病人护理在几个与许多医生，在何种程度上NH的医生专门提供NH护理，和组织策略NHS用于管理医生的关系（如就业或合同安排，认证，或监督）作为潜在的机制，以改善患者的结果接受急性后护理的NHS。为了完成这项研究，我将使用一个现有的数据库，一个全国代表性的样本合并机构A部分医疗保险索赔，疗养院的最小数据集，和NH医生组织战略的调查数据，扩大这个数据库，包括所有医疗保险部分B索赔的医生在样本中，以衡量医生的专业化在NHS。在急性期后护理政策和NH医务人员组织专家的指导下工作，我将：（1）测量HN将患者护理集中在少数医生与许多医生之间的程度与急性期后护理结果之间的关联（患者在NH入院后30天内再次入院，并成功出院到社区）;（2）测量NH护理中医生专业化对这些结果的影响;（3）测量NH医生组织策略对这些结果的影响。完成后，这些研究将提供有关急性后护理提供系统的可修改方面的新的关键信息，以告知NH政策和实践。这项工作还将帮助我建立一套技能，成为一名独立的调查员，评估各种医生实践模式的价值，以优化对患有多种慢性病的老年患者的护理服务。

项目成果

期刊论文数量（16）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

US internists' awareness and use of overtreatment guidelines: a national survey.

美国内科医生对过度治疗指南的认识和使用：一项全国调查。

DOI：
发表时间：
2017
期刊：
The American journal of managed care
影响因子：
0
作者：
Ryskina,KiraL;Holmboe,EricS;Bernabeo,Elizabeth;Werner,RachelM;Shea,JudyA;Long,JudithA
通讯作者：
Long,JudithA

Telephone vs. Web-based prescreening predicts early but not overall physician response to a mailed survey.

电话预筛与基于网络的预筛可以预测医生对邮寄调查的早期反应，但不能预测总体反应。