In-Home Caregiving and Use of Medical Services

描述(由申请人提供)：概念联系和新出现的文献表明，居家照看安排对残疾老年人使用医疗服务有影响。以前，较大的护理网络、无偿帮助的存在、较低的照顾者负担和较高的奖励水平，以及日常生活活动中没有未得到满足的需求，都与理想的健康结果和接受者进入永久疗养院的可能性较低有关。在这里，我们通过假设居家照看安排的这些属性表明可调动的可用资源的深度来帮助受助人进行个人护理和必要的医疗护理，从而扩展这一探索线。拟议的项目审查了居家护理安排的这些属性与医院结果之间的关系，这些属性被认为对居家照顾者促进适当医疗护理的能力特别敏感。这项前瞻性队列研究利用了1999年全国长期护理调查及其伴随的护理人员调查的数据，以及1999年调查完成后12个月内的医疗保险索赔数据。家庭护理安排和住院结果(特别是潜在的可预防住院、重复入院和延迟出院)之间的关系将使用多元回归模型来估计，该模型控制已知与感兴趣的结果相关的个人和照顾者特征，并特别关注患者发病率和疾病严重程度。拟议的研究将提供对居家照顾者在一个重要领域的影响的理解，该领域超出了通常归因于他们的结果的范围。这项工作的最终目标是制定支持照顾者和改善老年人健康的战略。这一试点项目的结果将为测量和数据收集工作提供信息，并解释预计于2006年7月在马里兰州巴尔的摩开始的多组分护理者干预的结果。

DESCRIPTION (provided by applicant): Conceptual links and a nascent literature suggest that in-home caregiving arrangements have a bearing on disabled older adults' use of medical services. Larger caregiving networks, the presence of unpaid help, lower levels of caregiver burden and higher levels of reward, and the absence of unmet need with activities of daily living have previously been linked to desirable health outcomes and a lower likelihood of permanent nursing home entry for recipients. Here we extend this line of inquiry by hypothesizing that these attributes of in-home caregiving arrangements are indicative of the depth of available resources that may be mobilized to assist recipients with personal care as well as necessary medical care. The proposed project examines the relationship between these attributes of in-home care arrangements and hospital outcomes that are thought to be particularly sensitive to the ability of in-home caregivers to facilitate appropriate medical care. This prospective cohort study draws on data from the 1999 National Long Term Care Survey, its accompanying Caregiver Survey, and Medicare claims data for the 12-month period following completion of the 1999 survey. The relationship between in-home caregiving arrangements and hospitalization outcomes (specifically, potentially preventable hospitalizations, repeat hospital admissions, and delayed discharges) will be estimated using multivariate regression models that control for individual and caregiver characteristics known to be related to the outcomes of interest, with particular attention to patient morbidity and severity of illness. The proposed research will provide an understanding of the influence of in-home caregivers in an important area that is beyond the scope of outcomes typically attributed to them. The ultimate goal of this work is to develop strategies that support caregivers and improve the health of older adults. Findings from this pilot project will inform measurement and data collection efforts, as well as interpretation of results from a multi-component caregiver intervention in Baltimore, Maryland that is expected to begin in July 2006.