Investigating Disparities in Home Health Access and Quality for Medicare Beneficiaries with Alzheimer's Disease and Related Dementias Following Recent Payment System Revisions

调查最近支付系统修订后患有阿尔茨海默病和相关痴呆症的医疗保险受益人在家庭健康获取和质量方面的差异

• 批准号: 10724842
• 负责人: Julia Burgdorf
• 金额: $ 33.48万
• 依托单位: VISITING NURSE SERVICE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10724842
• 关键词: Acute; Algorithms; Alzheimer' s disease patient; Alzheimer' s disease related dementia; American; COVID-19; Caring; Characteristics; Clinical; Communities; Community Healthcare; Community Physician; Community Surveys; Data; Data Set; Diagnosis; Disease; Disparity; Elderly; Emergency department visit; Enrollment; Ensure; Fee-for-Service Plans; Future; Geography; Goals; Grouping; Health; Home; Home Care Services; Home Health Agency; Hospitalization; Impaired cognition; Individual; Inpatients; Institution; Length of Stay; Linear Models; Link; Logistics; Measures; Medicaid; Medicare; Medicare claim; Modeling; Monitor; Nurses; Outcome; Outcome Measure; Patient Care; Patient-Focused Outcomes; Patients; Persons; Physicians; Policy Making; Race; Rehabilitation therapy; Reporting; Research; Research Personnel; Risk Adjustment; Sampling; Service delivery model; Services; Severities; Shock; Social Adjustment; Source; Subgroup; System; Testing; United States Centers for Medicare and Medicaid Services; Visit; Visiting Nurse; Work; aging in place; beneficiary; care delivery; career; community based service; community living; comorbidity; copayment; coronavirus disease; cost; experience; financial incentive; health assessment; health care delivery; health disparity; high risk; human old age (65+); member; negative affect; nursing skill; payment; post implementation; pre-pandemic; residence; skills; trend

PROJECT SUMMARY Of 5.4 million persons with Alzheimer's Disease and Related Dementias (ADRD) in the US, 70% live in the community and are at high risk for unmet care needs. Medicare home health (HH) is a crucial source of care for community-living older adults with ADRD, delivering skilled nursing, therapy, and aide services in the patient's home. Patients can enter HH following an inpatient stay (post-acute HH) or referral by a community physician (Community-Entry Home Health (CEHH)). Nearly half (44%) of Medicare HH episodes are CEHH. Those with ADRD are especially likely to access CEHH. Prior research shows that 30% of CEHH patients have ADRD, compared to just 12% of post-acute HH patients. Recent changes to Medicare HH reimbursement under the Patient-Driven Groupings Model (PDGM) adjust payment by referral source; PDGM is projected to reduce average reimbursement for CEHH by 11% while increasing average reimbursement for post-acute HH by 29% (holding other patient characteristics constant) and does not adjust for patient ADRD status. These changes have prompted concerns that PDGM will negatively impact CEHH patients, especially those with ADRD. The only existing analysis of PDGM's effects on HH utilization fails to examine differences by referral source (community vs post-acute), investigate impacts among vulnerable beneficiary subpopulations, such as those with ADRD, or study changes in patient outcomes. The goal of the proposed research is to assess PDGM's impact on CEHH access, care delivery, and outcomes for community-living older adults with ADRD. We will link Medicare claims, HH assessment, and HH agency data, along with geographic data from the American Community Survey, for a 100% sample of Medicare beneficiaries from 2019-2021. Specific aims are: (1) Characterize PDGM's impact on CEHH access for community-living Medicare beneficiaries with ADRD, (2) Determine PDGM's impact on CEHH care delivery (e.g., number and type of visits) for patients with ADRD, (3) Assess PDGM's association with CEHH outcomes (e.g., hospitalization, Emergency Department visits) for patients with ADRD. In all aims, we will adjust for social and clinical characteristics of the older adult, as well as characteristics of their zip code and state of residence, and the HH agency providing care. PDGM was implemented in 2020, but due to service disruptions related to COVID- 19, we consider 2019 as the “pre” period and 2021 as the “post” period (available evidence shows patient volume and average comorbidity scores stabilized by 2021, reflecting 2019 levels). This research is needed to assess whether a new payment system (PDGM) has contributed to disparities in HH access and quality for those with ADRD. Findings will provide the first evidence regarding PDGM's impacts on CEHH care for those with ADRD and could inform payment system revisions aimed at ensuring accessible, high-quality home-based care for this high-need subpopulation. This work is especially timely given the upward trend in HH utilization and growing numbers of community-living individuals with ADRD.

项目摘要 在美国有540万阿尔茨海默氏病和相关痴呆症（ADRD）的人中，有70％的生活 在社区中，面临未满足的护理需求的高风险。 Medicare Home Health（HH）是至关重要的来源 照顾社区生活的老年人，患有ADRD，提供熟练的护士，治疗和助手服务 病人的家。患者可以在住院住院（急性后HH）或社区推荐后进入HH 物理学（社区 - 进入家庭健康（CEHH））。近一半（44％）的Medicare HH发作是CEHH。 患有ADRD的人尤其有可能访问CEHH。先前的研究表明，30％的CEHH患者患有 ADRD，仅为急性后HH患者中的12％。 在患者驱动的分组模型（PDGM）下，Medicare HH报销的最新变化 通过推荐来源调整付款； PDGM预计将使CEHH的平均报销减少11％ 急性后HH的平均报销增加了29％（保持其他患者特征恒定） 并且没有适应患者ADRD状态。这些变化引起了人们对PDGM的负面关注 影响CEHH患者，尤其是患有ADRD的患者。对PDGM对HH的影响的唯一现有分析 利用率无法通过转诊来源（社区与急性后）检查差异，研究 脆弱的受益人亚群，例如ADRD或患者预后的研究变化。 拟议研究的目的是评估PDGM对CEHH访问，护理交付和 ADRD的社区生活的老年人的成果。我们将链接Medicare主张，HH评估和HH 代理数据以及美国社区调查的地理数据，用于100％的Medicare样本 2019 - 2021年的受益人。具体目的是：（1）表征PDGM对CEHH访问的影响 与ADRD的社区生活医疗保险受益人，（2）确定PDGM对CEHH护理交付的影响（例如， ADRD患者的访问人数和类型，（3）评估PDGM与CEHH结果的关联（例如， 住院，急诊务访问），用于ADRD患者。总的来说，我们将适应社会和 老年人的临床特征，以及其邮政编码和居住状态的特征，以及 HH机构提供护理。 PDGM于2020年实施，但由于与COVID相关的服务中断。 19，我们将2019年视为“前”时期，而2021年为“邮政”（可用证据表明患者量 到2021年的平均合并症得分稳定，反映了2019年的水平）。 需要这项研究来评估新的支付系统（PDGM）是否导致了差异 对于患有ADRD的人的HH访问和质量。调查结果将提供有关PDGM影响的第一个证据 在CEHH护理ADRD的人的情况下，可以为付款系统修订提供信息，以确保可访问， 高质量的家庭护理对这种高需求的亚群。这项工作特别及时地向上 HH利用率和ADRD的社区生活个人数量越来越多。