STATE POLICIES AND HEALTH SYSTEMS FACTORS ASSOCIATED WITH MULTIPLE TRANSITIONS

护理的不连续性是美国医疗保健系统中的一个主要问题。通过财政激励措施， 法规、联邦和州的政策可能会影响护理水平之间的转换数量和模式。 体弱多病、老年人的多次过渡与医疗差错、丧失亲人的家庭报告有关 信息的不连续性和功能的衰退。虽然研究记录了惊人的 尽管卫生保健利用存在地理差异，但很少有人记录卫生保健过渡的差异。 合并国家医疗保险索赔数据和最小数据集，这项研究将描述 四组老年人的护理过渡：1）长期入住疗养院（NH）的居民， 严重认知障碍; 2）死亡者; 3）髋部骨折手术后的老年人;以及4）人 75岁及以上，患有晚期结直肠癌，从急诊医院出院。目标1描述了 1999年至2000年七年期间的过渡模式和速度，重点是地理差异， 2006.目标2研究与较高的护理过渡率相关的卫生系统和州因素， 复杂的多站点过渡，以及州政策的变化是否与 过渡率。目标3检查患者结局（例如，功能下降、丧失家人 对临终关怀质量的看法），这些地区的临终关怀率和模式各不相同 过渡。目标4将是验证性和探索性的;确定护理主任和NH 行政人员的态度、看法和对机构政策的报告证实了地方的做法，即： 转换率。此外，这一目标将探讨国家政策如何影响过渡。知识来自于此 研究将指导有关护理过渡的公共政策，并改善对体弱、老年人和残疾人的护理协调。 美国人 概述：虚弱的老年人经常经历医疗保健环境的变化（即，健康护理 过渡）。这项研究将研究美国各地医疗保健转型的速度和类型如何变化 以及国家政策和当地医疗保健市场的特点如何影响这种转变。

Discontinuity of care is a major concern within the US Health Care System. Through financial incentives and regulations, federal and state policies may affect the number and patternof transitions across levels of care. Multiple transitions of frail, older persons have been associatedwith medical errors, bereaved family reports of information discontinuity, and functional decline. While research studies have documented striking geographic variation in health care utilization, few have documented the variation in health care transitions. Merging national Medicare Claims Data and the Minimum Data Set, this research will describe variation in care transitions for four cohorts of older adults: 1) long stay nursing home (NH) residents with moderate to severe cognitive impairment; 2) decedents ; 3) older persons following hip fracture surgery; and 4) persons age 75 and older discharged from an acute care hospital with advanced colorectal cancer. Aim 1 describes patterns and rates of transitions with a focus on geographic variation over a seven year period, 1999 to 2006. Aim 2 examines health system and state factors associated with higher rates of care transitions and complicated, multi-site transitions, and whether changes in state polices are associated with changes in the rate of transitions. Aim 3 examines patient outcomes (e.g. functional decline, bereaved family member perceptions of the quality of end of life care) in geographic regions with varying rates and patterns of care transitions. Aim 4 will be both confirmatory and exploratory; determines whether directors of nursing and NH administrators' attitudes, perceptions, and reports of institutional policies confirm the local practice viz. transition rates. Additionally, this aim willl explore how state policies effect transitions. Knowledge from this research will guide public policy regarding care transitions and improved coordination of care for frail, older Americans. Lay Summary: Frail, older persons often experience changes in settings of health care (i.e., a health care transition). This research will examine how the rates and type of health care transitions vary across the US and how state policies and characterisitics of the local health care market affect such transitions.