How Access Affects Outcomes of Rehabilitation Services

描述（由申请人提供）：随着人口老龄化，如果主要慢性疾病的年龄特异性患病率保持不变，到2049年，美国功能受限的人数将增加300%以上。虽然医疗干预有时可以显著改善身体机能，但对许多人来说，恢复功能能力是不现实的。重点转移到保护功能，减缓其衰退；预防继发性并发症。康复服务，包括物理治疗（PT）和职业治疗（OT），是这些努力的核心。很少有研究检查PT和OT的结果，因为它们在美国整个社区都是常规做法。这个项目将使用一项纵向的，针对65岁以上和65岁以下的医疗保险受益人的全国性调查（1994-2001年医疗保险当前受益人调查），并与受访者的医疗保险索赔相联系，以检查PT和OT的结果。医疗保险支付政策的一个重大变化——1997年的《平衡预算法案》（Balanced Budget Act）收紧了对康复服务的支付——将作为常规康复护理受限条件下的“自然实验”。拟议的研究旨在检查PT和OT服务强度与良好结果可能性之间的关系，包括较低的自我报告功能衰退率；整体健康状况恶化；日常生活活动（ADL）和工具性ADL依赖；制度化;急诊住院；受伤需要就医；褥疮的发展；购置辅助技术；社会隔离;和死亡。这项研究将对患有五种疾病的人进行调查：关节炎；中风;急性心肌梗死；慢性阻塞性肺病；以及下肢活动障碍，不管原因是什么。两个相互关联的假设将指导这项工作：(1)PT和OT强度的增加与更好的结果相关；(2)减少接受PT和OT的机会与较差的结果相关。这些假设将使用横断面和纵向分析进行检验；分析技术将包括时间序列、倾向评分、工具变量和比例风险回归模型。拟议研究的主要结果将是评估PT和OT的关联，作为全国常规实践和重要的护理结果。

DESCRIPTION (provided by applicant): With the aging population, the number of Americans with functional limitations will rise by over 300% by 2049 if the age-specific prevalence of major chronic conditions remains unchanged. While medical interventions can sometimes dramatically improve physical functioning, restoring functional abilities is unrealistic for many people. The focus shifts to preserving function, slowing its decline; and preventing secondary complications. Rehabilitation services, including physical therapy (PT) and occupational therapy (OT), are central to these efforts. Few studies have examined the outcomes of PT and OT as they are routinely practiced throughout communities in the United States. This project will use a longitudinal, nationwide survey of Medicare beneficiaries over and under age 65 (the 1994-2001 Medicare Current Beneficiary Surveys), linked with respondents' Medicare claims, to examine outcomes of PT and OT. A major change in Medicare payment policy -- the 1997 Balanced Budget Act, which tightened payments for rehabilitation services -- will serve as a "natural experiment" of conditions under which access to routine rehabilitation care is constrained. The proposed study aims to examine the association between the intensity of PT and OT services and likelihood of good outcomes, including lower rates of: self-reported functional decline; worsening overall health; activities of daily living (ADL) and instrumental ADL dependence; institutionalization; acute care hospitalization; injury prompting medical attention; decubitus ulcer development; purchase of assistive technology; social isolation; and death. The study will examine persons within five conditions: arthritis; stroke; acute myocardial infarction; chronic obstructive pulmonary disease; and lower extremity mobility problems, regardless of cause. Two inter-related hypotheses will guide this work: (1) increased intensity of PT and OT is associated with better outcomes; and (2) decreased access to PT and OT is associated with worse outcomes. These hypotheses will be tested using cross-sectional and longitudinal analyses; analytic techniques will include time series, propensity score, instrumental variable, and proportional hazards regression modeling. The primary outcome of the proposed study will be an assessment of the association of PT and OT, as routinely practiced nationwide and important outcomes of care.