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Health Care Use After Functional Disability: Opportunities to Improve the Care of Older Adults

功能性残疾后的医疗保健使用：改善老年人护理的机会

基本信息

批准号：
10259713
负责人：
Claire Kathryn Ankuda
金额：
$ 24.27万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
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：
2020-09-10 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10259713
关键词：
Accident and Emergency department Activities of Daily Living Acute Address Aging Award Bathing Caregivers Caring Cessation of life Characteristics Clinical Cohort Studies Communities Complex Cost Sharing Data Data Sources Dementia Development Development Plans Disabled Persons Disease Economic Factors Economic Policy Elderly Enrollment Event Family Fibrinogen Geography Goals Health Health Policy Health Services Health Status Health and Retirement Study Health care facility Health system Healthcare Heterogeneity Hip Fractures Home Home Health Agency Hospitalization Individual Institution K-Series Research Career Programs Lead Leadership Length of Stay Link Medical Medicare Medicare claim Mentors Mentorship Methodology Methods Minority Groups Modeling Monitor Morbidity - disease rate Nursing Homes Older Population Outcome Outcome Study Palliative Medicine Patients Pattern Patterns of Care Physicians Policies Population Poverty Primary Care Physician Provider Quality of Care Reporting Research Research Personnel Resources Role Sentinel Shapes Skilled Nursing Facilities Surveys System Training Translating Variant Walking base beneficiary career caregiving community setting cost disability experience flexibility functional disability functional status health economics high risk hospital bed hospital readmission improved innovation insight mortality multiple chronic conditions programs racial minority skills social socioeconomics trend

项目摘要

PROJECT SUMMARY/ABSTRACT Functional disability profoundly impacts the health and health care use of older adults, and yet functional status is not consistently monitored by health systems, nor routinely collected by Medicare. Patients and their families frequently struggle with inadequate support for these unrecognized needs. While specific diseases or multimorbidity have traditionally been the focus of research investigating high and potentially burdensome health care use, disability, defined as needing help performing activities of daily living (ADLs), may be a more critical and universal factor. The relationship between disability and health care use is complex: medical conditions may result in both disability and health care use, disability and unmet care needs can lead to health care use, and hospitalization itself can cause disability. Variation in health system features and practice patterns, such as the numbers of hospital beds and local levels of health care intensity, impact care patterns at a regional level and may influence the relationship between disability and health care use. Nationally, the Medicare Advantage (MA) program is rapidly expanding and offers increasing flexibility in supplemental benefits that could better support older adults with disability. However, older adults with functional disability are more likely leave MA plans and may receive care from lower quality skilled nursing facilities and home health agencies in MA. It is unknown if MA plans are shifting care from facilities to the community and to unpaid caregivers in order to reduce costs. The Paul Beeson Emerging Leaders Career Development Award in Aging will support my effort to address this gap through research that will examine the relationship between disability and health care use at three levels: the individual, health system, and health policy. In SA1, I will investigate the individual-level heterogeneity of health care use after the first report of ADL disability using the Medicare claims-linked National Health and Aging Trends Study (NHATS), which allows for identification of the month of disability onset. In SA2, I will use the Health and Retirement Study and data capturing regional characteristics to assess the influence of regional health system features on health care use after disability. In SA3, I will use NHATS linked to Medicare data to examine differences in care setting (i.e., community vs. institutional care) and caregiving (i.e., paid and unpaid caregiving) between older adults with functional disability in MA vs. traditional Medicare. These scientific aims link closely with a comprehensive development plan through which I will gain advanced methodological expertise in trajectory analysis and hierarchical modeling, clinical and systems understanding in geriatric disability, health economics and policy insight, and the leadership skills to translate my findings to policy change. This five-year project leverages my extensive experience conducting survey-based research, the resources of my institution, and the expertise of my mentors to identify opportunities to improve the care of older adults while catalyzing my development as an independent researcher working to improve Medicare policy for older adults with functional disability.

项目总结/文摘