Quality of Care for Dual-Eligible Beneficiaries in Managed Care Plans

项目摘要 Laura M. Keohane博士，MS是范德比尔特大学卫生政策系的助理教授 大学医学院。作为一名健康服务研究人员，Keohane博士试图识别和理解 政策如何解决与年龄、残疾和社会经济环境有关的卫生保健障碍。这 培训补助金将支持她的职业目标，成为一个领先的独立调查员在护理质量， 低收入老年人，特别是拥有Medicare和Medicaid的双重资格受益人 覆盖这些人口包括该县一些需求最高、成本最高的老年人。期间 奖励期间，Keohane博士将获得定性研究方法，调查和医疗补助方面的额外专业知识 数据分析和老年人的临床健康结果。她的主要导师梅林达·邦廷博士是一位 全国公认的健康经济学家与广泛的医疗保险政策的知识，和她的共同导师，博士。 大卫史蒂文森，是一个领先的专家在临终关怀和长期服务和支持。邦廷博士和 博士史蒂文森将主持一个由知名研究人员和临床医生组成的咨询委员会， 在评估老年人护理质量方面提供指导。Keohane博士的培训活动将包括 方法课程作业，指导阅读护理质量，并对医疗保健提供临床实习， 老年人一套互补的研究项目将为Keohane博士提供应用新技术的机会。 调查双重资格受益人新出现的卫生政策问题的技能： 护理计划虽然超过四分之一的双重资格受益人通过一个 管理式护理计划，很少有证据表明这些计划是否对健康有更好的结果。 老年人有复杂的健康需求和有限的社会经济资源。为了弥补这些差距，第一 aim将使用全国调查数据来比较双重资格者的健康和功能状态随时间的变化。 与传统医疗保险相比，管理式医疗计划的受益人。第二个目标将采用定性数据 分析以了解管理式护理计划如何通过履行质量报告影响健康结果 要求.第三个目标是审查具体报告要求的改进， 记录参与预先护理计划活动，与更好的临终关怀相关。 成果。最后，第四个目标将评估医疗补助福利的减少是否会对 双重资格受益人的护理质量以及参与管理式护理计划是否减轻了这一点 冲击总的来说，这些目标的结果将为重要的政策决定提供依据 关于管理式医疗在改善低收入老年人健康状况方面的作用。通过提供 进行混合方法研究所需的培训，并更好地了解 该奖项将使Keohane博士成为一名成功的独立研究人员。

PROJECT ABSTRACT Laura M. Keohane, PhD, MS is an Assistant Professor in the Department of Health Policy at the Vanderbilt University School of Medicine. As a health services researcher, Dr. Keohane seeks to identify and understand how policy can address health care barriers related to age, disability, and socioeconomic circumstances. This training grant will support her career goal of becoming a leading independent investigator in quality of care for low-income older adults and specifically dual-eligible beneficiaries who have both Medicare and Medicaid coverage. This population includes some of the county's highest-need, highest-cost elderly adults. During the award period, Dr. Keohane will gain additional expertise in qualitative research methods, survey and Medicaid data analysis, and clinical health outcomes for older adults. Her primary mentor, Dr. Melinda Buntin, is a nationally recognized health economist with extensive Medicare policy knowledge, and her co-mentor, Dr. David Stevenson, is a leading expert in end-of-life care and long-term services and supports. Dr. Buntin and Dr. Stevenson will chair an advisory committee of established researchers and clinicians who will provide mentorship in evaluating quality of care for aging populations. Dr. Keohane's training activities will include methods coursework, guided readings on quality of care, and a clinical practicum on health care delivery for older adults. A complementary set of research projects will provide opportunities for Dr. Keohane to apply new skills to investigating an emerging health policy issue for dual-eligible beneficiaries: quality of care in managed care plans. Although over one in four dual-eligible beneficiaries receives Medicare benefits through a managed care plan, there is little evidence demonstrating whether these plans have better health outcomes for older adults with complex health needs and limited socioeconomic resources. To address these gaps, the first aim will use national survey data to compare health and functional status changes over time for dual-eligible beneficiaries in managed care plans versus traditional Medicare. The second aim will employ qualitative data analysis to understand how managed care plans may influence health outcomes by fulfilling quality reporting requirements. The third aim will examine whether improvements in a specific reporting requirement, documenting engagement in advance care planning activities, were associated with better end-of-life outcomes. Finally, the fourth aim will evaluate whether a reduction in Medicaid benefits negatively affected quality of care for dual-eligible beneficiaries and whether participation in managed care plans mitigated this impact. Collectively, the results from these aims will provide evidence that informs important policy decisions about the role of managed care in improving health outcomes for low-income elderly adults. By providing the training necessary to conduct mixed-methods research and to better understand the clinical health needs of aging adults, this award will enable Dr. Keohane to become a successful independent researcher.