Resource Use and Patient Outcomes in Medicare Home Care

描述(由申请人提供)：临床和行政职位的护士在设计和向医疗保险患者提供家庭护理服务方面发挥着关键作用。如今，联邦医疗保险家庭护理报销由预期支付系统(PPS)管理，医疗保险家庭护理质量越来越注重通过新的基于结果的质量改进(OBQI)计划最大化患者结果。然而，关于联邦医疗保险PPS时代的实际人力资源使用模式，帮助联邦医疗保险家庭护理决策者的证据仍然很少。此外，对家庭护理入院时导致不良结局的患者水平的风险因素知之甚少，包括住院、家庭护理出院时的功能障碍以及家庭护理出院时的临床症状频率和严重程度。我们最初由NINR资助的研究(R01 NR05081)基于俄亥俄州1,284名医疗保险家庭护理患者，到目前为止的结果已经证明了这些知识差距。在此应用程序中，我们建议通过使用PPS时代具有全国代表性的医疗保险家庭护理患者样本的数据，直接建立在我们最初的研究基础上。我们将使用与联邦医疗保险索赔数据相关联的结果评估信息集数据来实现以下具体目标：(1)确定因住院而结束医疗保险家庭护理的最重要的患者层面的风险因素，考虑家庭护理机构因素和县级市场因素的潜在影响；(2)确定出院后留在家中的患者功能障碍和临床症状较大的最重要的患者层面风险因素，考虑家庭护理机构因素和县级市场因素的潜在影响；(3)在出院后留在家中的患者中，确定特定于工作人员的资源使用措施与功能残疾和临床症状之间的关系，考虑患者层面的风险因素、家庭护理机构因素和县级市场因素的影响；(4)确定同一家庭健康资源组(HHRGs)中的患者的住院模式、功能和临床结果以及特定于工作人员的资源使用的模式和预测因素。HHRGs用于计算根据Medicare PPS向机构支付的款项。患者层面的风险因素将根据卫生服务使用和结果的安徒生模型进行组织。患者结局评估将包括住院时间、功能残疾、疼痛频率限制活动和呼吸困难严重程度。资源使用措施将包括护士、康复治疗师和其他临床工作人员进行家访的数量和强度。研究结果将有助于为PPS和OBQI时代的医疗保险家庭护理机构决策者提供有用的科学证据。

DESCRIPTION (provided by applicant): Nurses in clinical and administrative positions play critical roles in the design and delivery of home care services to Medicare patients. Medicare home care reimbursement today is governed by a prospective payment system (PPS), and quality of Medicare home care is increasingly focused on maximizing patient outcomes through the new Outcomes Based Quality Improvement (OBQI) initiative. Evidence to assist Medicare home care decision makers, however, remains sparse regarding actual staff resource use patterns in the Medicare PPS era. Moreover, little is known about patient-level risk factors at home care admission that lead to unfavorable outcomes including hospitalization, functional disability at home care discharge, and clinical symptom frequency and severity at home care discharge. Results to date from our initial NINR-funded study (R01 NR05081), based on 1,284 Medicare home care patients in Ohio, have yielded evidence to inform these knowledge gaps. In this application, we propose to build directly on our initial study by using data from a nationally representative sample of Medicare home care patients in the PPS era. We will use Outcome Assessment Information Set data linked to Medicare claims data to achieve the following specific aims: (1) To determine the most important patient-level risk factors for ending an episode of Medicare home care due to hospitalization, accounting for potential effects of home care agency factors and county-level market factors; (2) To determine the most important patient-level risk factors for greater functional disability and clinical symptoms among patients remaining at home after discharge, accounting for potential effects of home care agency factors and county-level market factors; (3) To determine how staff-specific resource use measures are associated with functional disability and clinical symptoms among patients remaining at home after discharge, accounting for the effects of patient-level risk factors, home care agency factors, and county-level market factors; (4) To determine patterns and predictors of hospitalization, functional and clinical outcomes, and staff-specific resource use, among patients grouped within the same Home Health Resource Groups (HHRGs). HHRGs are used to calculate payments to agencies under Medicare PPS. Patient-level risk factors will be organized according to the Andersen model of health services use and outcomes. Patient outcome measures will include hospitalization, functional disability, pain frequency limiting activity, and dyspnea severity. Resource use measures will include amount and intensity of home visits made by nurses, rehabilitation therapists, and other clinical staff. Results will help provide useful scientific evidence to Medicare home care agency decision makers in the PPS and OBQI eras.