Evaluating Policy Solutions Aimed at Improving Hospice Care Access in Rural Areas

项目总结/摘要 项目4（Gilstrap）：评估旨在改善农村地区临终关怀服务的政策解决方案 2016年，近150万医疗保险受益人参加了临终关怀，如果不是更多的话， 符合条件，但选择不参加。临终关怀可以为病人和护理人员提供无数的好处， 已被证明可以减少生命结束时的无效护理，使注册不足成为一个问题。只有34%的 农村死亡者参加临终关怀，而城市地区为51%，农村入学率不足 到生命末期的更高的急症护理率。2016年，医疗保险和医疗补助服务中心（CMS） 医疗保险选择模式（MCCM）这项自愿方案旨在解决 “可接受性”，临终关怀准入的一个方面，允许患者在不停止治疗的情况下参加临终关怀 因为他们的临终状态尽管早期的结果表明，该计划增加了入学人数， 目前还不清楚MCCM计划在农村地区的表现如何，预测的因素是什么， 农村地区的成功以及农村临终关怀机构是否满足了对服务的需求。 本项目将利用相关、及时和创新的分析， 方法.随着研究小组努力研究MCCM在农村地区的影响， 农村地区临终关怀扩展的障碍，并模拟各种政策解决方案的估计影响， 将利用大型数据集，新颖的人行横道，定性访谈和模拟建模。的工作 该项目最终将准备PI Gilstrap博士开发并提交R 01申请，目的是 实施和测试该补助金中确定的策略，以量化其对农村临终关怀入学率的影响。

PROJECT SUMMARY/ABSTRACT Project 4 (Gilstrap): Evaluating Policy Solutions Aimed at Improving Hospice Care Access in Rural Areas In 2016, almost 1.5 million Medicare beneficiaries enrolled in hospice and an equal number, if not more, were eligible but chose not to enroll. Hospice can provide a myriad of benefits for patients and caregivers, and has been shown to decrease futile care at the end of life, making under-enrollment a problem. With only 34% of rural decedents enrolled in hospice as compared to the 51% in urban areas, rural under-enrollment contributes to a higher rate of acute care at end of life. In 2016, the Center for Medicare and Medicaid Services (CMS) launched the Medicare Care Choices Model (MCCM). This voluntary program aimed to address the “acceptability,” aspect of hospice access, by allowing patients to enroll in hospice without stopping treatment for their terminal condition. Though early results suggest that the program increased enrollment and decreased spending, it remains unclear how the MCCM program performed in rural areas, what factors predicted success in rural areas, and whether increased demand for services was met by rural hospice agencies. This project will investigate these gaps in knowledge using relevant, timely, and innovative analyses and methods. As the research team works to examine the impact of MCCM in rural areas, determine the residual barriers to hospice expansion in rural areas, and model the estimated impacts of various policy solutions, they will leverage large data sets, novel crosswalks, qualitative interviews, and simulation modeling. The work on this project will ultimately prepare the PI, Dr. Gilstrap, to develop and submit an R01 application with the aim of implementing and testing strategies identified in this grant to quantify their impact on rural hospice enrollment.