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

项目摘要 Laura M.Keohane博士，硕士，范德比尔特大学卫生政策系助理教授 大学医学院。作为一名卫生服务研究人员，Keohane博士试图识别和理解 政策如何解决与年龄、残疾和社会经济状况有关的卫生保健障碍。这 培训补助金将支持她成为护理质量方面领先的独立调查员的职业目标 低收入老年人，特别是同时拥有医疗保险和医疗补助的双重资格受益人 覆盖范围。这一群体包括一些该县需求最高、花费最高的老年人。在.期间 在获奖期内，Keohane博士将在定性研究方法、调查和医疗补助方面获得更多专业知识 数据分析，以及老年人的临床健康结果。她的主要导师梅林达·邦恩博士是一位 拥有广泛的医疗保险政策知识的全国公认的卫生经济学家和她的共同导师Dr。 大卫·史蒂文森是临终关怀和长期服务与支持方面的领先专家。邦恩博士和 史蒂文森博士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，他们将为 在评估老龄人口护理质量方面的指导作用。Keohane博士的培训活动将包括 方法课程作业、关于护理质量的指导性读物和关于医疗保健交付的临床实践 上了年纪的人。一系列互补的研究项目将为Keohane博士提供应用新技术的机会 为符合双重条件的受益人调查新出现的卫生政策问题的技能：有管理的护理质量 护理计划。尽管超过四分之一的双重资格受益人通过 管理保健计划，几乎没有证据表明这些计划是否对 老年人有复杂的健康需求和有限的社会经济资源。为了解决这些差距，第一个 AIM将使用全国调查数据来比较双重符合条件的人随着时间的推移健康和功能状况的变化 管理式医疗计划的受益人与传统医疗保险的受益人。第二个目标将使用定性数据 分析以了解管理型医疗计划如何通过履行质量报告来影响健康结果 要求。第三个目标将审查具体报告要求的改进， 记录提前护理计划活动中的参与度，与更好的生命结束相关 结果。最后，第四个目标将评估医疗补助福利的减少是否会产生负面影响 双重资格受益人的护理质量以及参与管理保健计划是否缓解了这一问题 冲击力。总而言之，这些目标的结果将为重要的政策决策提供依据 关于管理性保健在改善低收入老年人健康结果方面的作用。通过提供 进行混合方法研究和更好地了解患者的临床健康需求所需的培训 对于老年人来说，这个奖项将使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.