PHYSICAL AND OCCUPATIONAL THERAPY FOR OLDER PERSONS

描述（由申请人提供）：以社区为基础的老年人，特别是 那些有功能限制和残疾的人， 提供者维持和/或改善他们的健康和功能能力。 物理治疗师和职业治疗师代表了一组医疗保健 主要专注于改善、维持或限制衰退的供应商 老年人的功能能力。的广泛目标 拟议的研究是为了促进我们对获得和 社区老年人物理和职业治疗的效果 人士这项研究将以人口为基础，分析几年的数据 医疗保险当前受益人调查。研究的第一个目的是 确定治疗使用的决定因素。将进行分析，以确定 与使用相关的易感性、使能性和需求特征 物理和职业治疗。在家中使用治疗的决定因素， 此外，亦会确定门诊病人的情况。最后， 诱发，使能和需要的特征和强度之间的关系， 将检查治疗使用情况。研究的第二个目的是研究 治疗使用与功能状态变化之间的关系。的用户 将确定物理和职业治疗，并进行分析， 进行检查治疗使用强度与 功能状态的变化，同时控制患者特征， 疾病严重性。检查功能状态变化的可行性 使用者和非使用者的物理和职业治疗也将 使用工具变量估计或病例对照方法进行探索。 很少有人知道社区老年人是否有适当的 获得治疗服务。关于有形和无形资产有效性的数据 为社区老年人提供的职业治疗也很有限。因为 最近医疗保险报销的变化直接影响了 提供治疗服务，审查使用和 这些服务的有效性是及时的，可能会告知未来的医疗保险 政策

DESCRIPTION (provided by applicant): Community based older persons, especially those with functional limitations and disability, use a variety of health care providers to maintain and/or improve their health and functional capabilities. Physical and occupational therapists represent one group of health care providers that primarily focus on improving, maintaining, or limiting decline in the functional capabilities of the older person. The broad objective of the proposed study is to advance our understanding of the access to and effectiveness of physical and occupational therapy for community based older persons. This study will be population based, analyzing several years of data from the Medicare Current Beneficiary Survey. The first aim of the study is to identify determinants of therapy use. Analyses will be conducted to identify predisposing, enabling, and need characteristics associated with the use of physical and occupational therapy. Determinants of therapy use in the home or outpatient setting will also be identified. And finally, the relationship between predisposing, enabling, and need characteristics and intensity of therapy use will be examined. The second aim of the study is to examine the relationship between therapy use and changes in functional status. Users of physical and occupational therapy will be identified and analyses will be conducted to examine the relationship between intensity of therapy use and changes in functional status, while controlling for patient characteristics and illness severity. The feasibility of examining changes in functional status among users and nonusers of physical and occupational therapy will also be explored using instrumental variable estimation or a case-control approach. Little is known about whether community based older persons have appropriate access to therapy services. Data on the effectiveness of physical and occupational therapy for community based older persons is also limited. Because recent changes in Medicare reimbursement have had a direct impact on the provision of therapy services, examining issues surrounding the use and effectiveness of these services is timely and may inform future Medicare policy.