Post-acute Care Outcomes of Patients with Alzheimer's Disease and Related Dementias: the Role of Skilled Nursing Facility Specialists

项目摘要 每年有超过110万名患者在急性期后进入专业护理机构（SNF）接受急性期后护理。 住院治疗阿尔茨海默病或相关痴呆症（ADRD）患者预后差， 变量考虑到ADRD患者的临床复杂性和护理协调需求， 改善接受SNF治疗的ADRD患者结局的解决方案是通过医生， 专注于SNF护理。“SNFists”（即，SNF患者占其大多数的医生 （实践）正变得越来越普遍。我们之前的研究发现， 2012年至2015年的SNFists，在各个市场之间具有高度的可变性。在这项研究中，我们将研究 专业从事SNF护理的医生是否能改善功能结局， ADRD患者可避免的医疗保健利用（如再次入院），接受急性后 在SNF中的护理。为了实现这些目标，我们将扩展现有的医疗保险索赔和SNF数据集 医疗保险按服务收费受益人从急性护理医院出院到 2012年至2019年的SNF。使用这个数据库，我们将研究医生专业化的趋势， SNF护理在市场，设施和医生特征的背景下。接下来，我们将衡量 SNF护理专业医生对ADRD患者结局和医疗保健利用的影响， 差中差跨时间匹配。最后，我们将对关键人物进行半结构化面试。 SNF人员（例如，护理主任，医疗主任），以定量确定实践策略和护理 基于患者结局，医生在高性能SNF与低性能SNF中的流程不同 关于ADRD完成后，这些研究将为实践和政策提供信息，以优化（增加或减少） 急性护理患者可以获得专门从事基于SNF的护理的医生。调查结果将用于 制定干预措施，以提高ADRD患者基于SNF的急性期后护理的价值。

PROJECT SUMMARY Over 1.1 million patients admitted annually to skilled nursing facilities (SNFs) for post-acute care after a hospitalization have Alzheimer’s Disease or Related Dementias (ADRD), and their outcomes are poor and variable. Given the high clinical complexity and care coordination needs of patients with ADRD, one potential solution to improving the outcomes of patients with ADRD receiving SNF care is through physicians who specialize in SNF-based care. “SNFists” (i.e., physicians for whom SNF patients comprise the majority of their practice) are becoming increasingly common. Our prior work found a 37% increase in the prevalence of SNFists from 2012 to 2015, with a high degree of variability across markets. In this study, we will examine whether physicians specializing in SNF-based care improve functional outcomes and reduce potentially avoidable healthcare utilization (such as hospital readmissions) of patients with ADRD receiving post-acute care in SNFs. To accomplish these goals, we will expand an existing dataset of Medicare claims and SNF clinical assessment data for Medicare fee-for-service beneficiaries discharged from an acute care hospital to a SNF from 2012 through 2019. Using this database, we will examine the trends in physician specialization in SNF care in the context of market, facility, and physician characteristics. Next, we will measure the impact of physician specialization in SNF care on the outcomes and healthcare utilization of patients with ADRD using difference-in-differences cross-temporal matching. Lastly, we will conduct semi-structured interviews with key SNF personnel (e.g., director of nursing, medical director) to quantitatively identify practice strategies and care processes that differ between physicians in high- vs. low-performing SNFs based on the outcomes of patients with ADRD. When complete, these studies will inform practice and policy to optimize (increase or reduce) post- acute care patients’ access to physicians who specialize in SNF-based care. The findings will be used to develop interventions to improve the value of SNF-based post-acute care for patients with ADRD.