Post-Acute Care Transitions for Older Adult Medicare Beneficiaries with Serious Mental Illness

患有严重精神疾病的老年医疗保险受益人的急性后护理过渡

• 批准号: 10772386
• 负责人: Taylor I Bucy
• 金额: $ 3.88万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10772386
• 关键词: Post; Acute; Care; Transitions; Older

PROJECT SUMMARY/ABSTRACT Roughly 1.5 million Medicare patients receive care in a skilled nursing facility (SNF) following acute hospitalization each year. Older adults (65+ years) with serious mental illness (SMI) are a large and growing segment of the SNF population, with specific needs that leave these individuals vulnerable to gaps or errors in care. Understanding how older adults with SMI are connected to post-acute SNF care and how they transition out of post-acute SNF care is essential to ensuring access to an appropriate level of services and high-quality care across the continuum. To date, there has been little work characterizing the post-acute care (PAC) trajectory of older adults with SMI. This study proposes two aims. First, I will (1) assess the extent to which SNF placement patterns differ for patients with SMI. This is motivated by the concern that hospitals are known to invest selectively with SNF partners in improved transitional care practices; if these investments are not aligned with where patients with SMI are sent for care, care disparities may persist or worsen over time. To assess SNF placement patterns, I will describe patterns of hospital to SNF discharge for older adults with and without (a) narrow groupings of SMI (schizophrenia, bipolar disorder), and (b) broad groupings of SMI (narrow SMI + major depression, anxiety, compulsive disorders) as compared to conditions targeted by the hospital readmission reduction program (HRRP). Patients with HRRP conditions are a useful comparison group as they represent populations where hospitals are most likely to have invested in high-quality care transitions to reduce the risk of penalties for hospital readmission. I will use a discrete choice model to evaluate patterns of hospital discharge to preferred-SNF partners to determine whether older adults with SMI have equitable access to hospitals’ more preferred SNF partners, and if this is moderated by the presence of HRRP conditions. In my second aim, I will (2) identify patient-, facility-, and county-level characteristics associated with discharge of older adults with SMI to the community within the 100-day post-acute period. Characterizing factors associated with return to community rather than conversion to long-stay (100+ days) is important given that services provided in the home or community are of higher value and in alignment with patient preferences. I will use a three-level mixed effects model to identify factors related to whether an older adult with SMI is discharged to the community following a SNF stay. This research quantifies (1) how older adult patients with SMI sort into SNFs; and (2) patient, facility, and county-level geographic factors associated with community discharge following a SNF stay, an important component of high-quality care. By identifying where older adults with SMI receive SNF care and how this influences their care trajectory, this work will generate key insights meant to guide policymakers and organizational leaders in the evaluation and improvement of payment/incentive structures and regulatory requirements that affect care delivery for this population.

项目摘要/摘要 大约有150万名医疗保险患者在急性脑梗死后接受专业护理机构（SNF）的护理。 每年住院。患有严重精神疾病（SMI）的老年人（65岁以上）是一个庞大且不断增长的群体。 SNF人口的一部分，有特殊的需求，使这些人容易受到差距或错误， 在乎了解患有SMI的老年人如何与急性SNF后护理联系起来以及他们如何过渡 从急性后SNF护理是必不可少的，以确保获得适当水平的服务和高质量的 在整个连续体中进行护理。到目前为止，很少有工作特点后急性护理（PAC） 老年人SMI的轨迹。本研究提出两个目标。首先，我将（1）评估 SMI患者的SNF放置模式不同。这是出于对医院被称为 选择性地与SNF合作伙伴投资于改善过渡性护理实践;如果这些投资不符合 与重度精神病患者被送往护理的地点一致，护理差异可能会持续存在或随着时间的推移而恶化。到 评估SNF安置模式，我将描述老年人的SNF出院模式， 没有（a）SMI的窄分组（精神分裂症、双相情感障碍）和（B）SMI的宽分组（窄分组 重度抑郁症、焦虑症、强迫症）与医院针对的疾病相比 减少再入院计划（HRRP）。HRRP患者是一个有用的对照组，因为他们 代表医院最有可能投资于高质量护理过渡的人群，以减少 再入院的处罚风险。我将使用离散选择模型来评估医院模式 出院到首选SNF伴侣，以确定患有SMI的老年人是否有平等的机会获得 医院更喜欢的SNF合作伙伴，如果这是由HRRP条件的存在缓和。在我 第二个目标，我将（2）确定与出院相关的患者、机构和县级特征， 在急性期后100天内，将患有SMI的老年人送到社区。表征相关因素 返回社区而不是转换为长期住宿（100天以上）是很重要的，因为服务 在家庭或社区提供的服务具有更高的价值，并符合患者的偏好。我会用 三水平混合效应模型，以确定与SMI老年人是否出院相关的因素， 在SNF逗留后的社区这项研究量化了（1）老年SMI患者如何分为 SNF;（2）与社区出院相关的患者、机构和县级地理因素 在SNF停留后，这是高质量护理的重要组成部分。通过确定老年人SMI 接受SNF护理以及这如何影响他们的护理轨迹，这项工作将产生关键的见解， 指导政策制定者和组织领导者评估和改进支付/激励措施 影响为这一人群提供护理的结构和监管要求。