In-Home Caregiving and Use of Medical Services

描述（由申请人提供）：概念联系和一个新生的文献表明，在家里照顾安排有残疾老年人使用医疗服务的影响。更大的护理网络，无偿帮助的存在，照顾者的负担较低，奖励水平较高，以及没有未满足的日常生活活动需求，以前被认为与理想的健康结果和接受者进入永久养老院的可能性较低有关。在这里，我们延伸这条调查线的假设，这些属性的家庭护理安排是可用资源的深度，可以调动，以协助受助人的个人护理以及必要的医疗保健的指示。拟议的项目研究这些属性之间的关系，在家庭护理安排和医院的结果，被认为是特别敏感的能力，在家庭照顾者，以促进适当的医疗护理。这项前瞻性队列研究利用了1999年国家长期护理调查的数据，其附带的护理人员调查，以及1999年调查完成后12个月内的医疗保险索赔数据。将使用多变量回归模型来估计家庭护理安排与住院结局（具体而言，潜在可预防的住院、重复住院和延迟出院）之间的关系，该模型控制已知与关注结局相关的个人和护理人员特征，特别关注患者发病率和疾病严重程度。拟议的研究将提供一个家庭照顾者在一个重要领域的影响力的理解，这是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。这一试点项目的调查结果将为计量和数据收集工作提供信息，并解释预计将于2006年7月开始的马里兰州巴尔的摩多部分护理人员干预的结果。

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.