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Post-acute care of older adults: the role of skilled nursing facility specialists

老年人的急性后期护理：熟练护理机构专家的作用

基本信息

批准号：
10226907
负责人：
Kira L Ryskina
金额：
$ 41.7万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10226907
关键词：
Acute Administrator Caring Characteristics Clinical Clinical assessments Communication Communities Complex Continuity of Patient Care Data Data Set Databases Destinations Elderly Emergency department visit Familiarity Fee-for-Service Plans Frail Elderly Goals Health care facility High Prevalence Hospitalization Hospitals Human Resources Incentives Intervention Interview Length of Stay Link Measures Medicare Medicare claim Nurse Administrator Nursing Homes Nursing Staff Outcome Ownership Patient Care Patient-Focused Outcomes Patients Penetration Physicians Policies Population Prevalence Primary Care Physician Process Protocols documentation Quality of Care Resources Role Sampling Site Skilled Nursing Facilities Specialist Structure Time Training Work acute care aging population base beneficiary bundled payment cost experience functional outcomes functional status health care service utilization hospital readmission improved improved outcome medical schools medical specialties physical therapist provider factors trend

项目摘要

PROJECT SUMMARY Post-acute care in skilled nursing facilities (SNFs) is common, and outcomes are poor and variable. Over the past decade, SNFs have been a target of efforts to improve outcomes while controlling spending, but robust gains remain elusive. Our prior work showed that the number of physicians who specialize in SNF-based care (i.e., “SNFists”) grew rapidly over the past decade. In this study, we will examine whether physicians specializing in SNF-based care improve functional outcomes and reduce potentially avoidable healthcare utilization (such as hospital readmissions) of patients receiving post-acute care in SNFs. We will also examine patient functional outcomes and healthcare utilization of SNFists vs. non-SNFists under value-based purchasing initiatives. To accomplish these goals, we will expand an existing dataset of Medicare claims and SNF clinical assessment data for Medicare fee-for-service beneficiaries discharged from an acute care hospital to a SNF from 2012 through 2018. Using this database, we will examine the trends in physician specialization in SNF care in the context of value-based purchasing (i.e., whether the discharging hospital participated in bundled payments or an Accountable Care Organization), market competition, and other market and physician characteristics. Next, we will measure the impact of physician specialization in SNF care on patient outcomes and potentially avoidable healthcare utilization using difference-in-differences cross-temporal matching. Lastly, we will conduct semi-structured interviews with key personnel (e.g., director of nursing) in SNFs to quantitatively identify training, practice strategies and care processes that differ between physicians who specialize in SNF care and those who do not. When complete, these studies will inform practice and policy to optimize (increase or reduce) post-acute care patients' access to physicians who specialize in SNF-based care.

项目总结在熟练护理机构(SNF)进行急性后护理是很常见的，结果很差，而且变化无常。超过了过去十年，瑞士央行一直是努力在控制支出的同时改善结果的目标，但表现强劲收益仍然难以捉摸。我们之前的工作表明，专门从事基于SNF的护理的医生数量 (即“SNFist”)在过去十年中迅速增长。在这项研究中，我们将检查医生是否专注于基于SNF的护理改善功能结果并减少潜在的可避免的医疗保健在SNF接受急诊后护理的患者的利用情况(如再次入院)。我们还将检查基于价值的SNFist与非SNFist的患者功能结局和医疗利用采购计划。为了实现这些目标，我们将扩展现有的联邦医疗保险索赔和急诊医院出院医疗保险费用受益人临床评估数据从2012年到2018年。使用这个数据库，我们将检查医生专业化的趋势在以价值为基础的采购背景下的SNF护理(即，出院医院是否参与捆绑支付或责任护理组织)、市场竞争以及其他市场和医生特点。接下来，我们将测量SNF护理中医生专业化对患者结局的影响以及使用差异差异跨时间匹配的潜在可避免的医疗保健利用。最后，我们将对SNF的关键人员(如护理总监)进行半结构化面试，以定量确定不同医生之间的培训、执业策略和护理流程专门从事SNF护理和那些不这样做的人。完成后，这些研究将为实践和政策提供信息，以优化(增加或减少)急诊后患者与以SNF为基础的专科医生的联系关心。