Access to Medicare Hospice for Nursing Home Residents

描述：最近的研究表明，医疗临终关怀提供 临终护理之家（NH）居民的重要福利。研究表明 临终关怀登记与居民有更大的可能性相关， 他们的疼痛评估和管理， 在生命的最后阶段住院。然而，在医疗保险临终关怀登记是 不适用于所有居民。NH居民只有在NH的情况下才能选择临终关怀医院 与临终关怀提供者签订了合同，实际上，并非所有的NH都有这样的合同。 合同.此外，并不是所有能够获得临终关怀的NH居民都选择 NH和临终关怀提供者的利益和激励可能会影响 这个决定。了解这种双层选择过程 职能是至关重要的，以了解获得临终关怀的NHs和 发展最充分考虑选择的统计和经济模式 偏见 在这个拟议的项目中，Gozalo博士将研究 医疗临终关怀福利成为提供给身患绝症的NH居民， 如果有，居民选择福利的过程。他 提出了一个模型的内生决策，利用丰富的 纵向数据集连接医疗保险索赔，疗养院和临终关怀 提供者数据和最小数据集（MDS）临床信息， 俄亥俄州。本研究目的为：（1）测量护理院、安宁疗护的效果 提供者和市场特征对临终关怀护理的可获得性 家庭，（2）衡量病人，疗养院和临终关怀的影响 医疗保险临终关怀福利的选择上的提供者特征， 符合条件的疗养院患者。本研究中的模型和数据 将用于制定R01提案，并在最后提交 项目期间。该项目以及后续工作将对 决策者监测临终关怀的提供，并决定未来的 医疗保险临终关怀福利管理的变化。

DESCRIPTION: Recent research suggests that Medicare hospice care provides important benefits to dying nursing home (NH) residents. Research shows hospice enrollment is associated with greater probability of residents having their pain assessed and managed with a lesser probability of being hospitalized at the end-of-life. However, enrollment in Medicare hospice is not available to all NH residents. NH residents can only elect hospice if a NH has a contract with a hospice provider, and in practice, not all NHs have such contracts. Furthermore, not all NH residents with access to hospice choose the benefit and incentives of the NH and hospice providers will likely influence this decision. An understanding of how this double-layer selection process functions is essential to understanding access to hospice in NHs and to developing statistical and economic modes that most fully consider selection biases. In this proposed project Dr. Gozalo will examine the process by which the Medicare hospice benefit becomes available to terminally ill NH residents, and when available, the process by which the residents select the benefit. He proposes a model of endogenous decision making that takes advantage of a rich longitudinal data set linking Medicare claims, nursing home and hospice providers data and Minimum Data Set (MDS) clinical information in the state of Ohio. The study aims are: (1) measure the effects of nursing homes, hospice providers and market characteristics on the availability of hospice in nursing homes, and (2) Measure the effects of patient, nursing home and hospice provider characteristics on the election of Medicare hospice benefit by eligible nursing home patients. The model and data emanating from this study will be used in the development of an R01 proposal to be submitted at the end of the project period. This project, and subsequent work, will be important to policymakers for monitoring hospice care provision and for deciding on future changes in the administration of the Medicare hospice benefit.