How Access Affects Outcomes of Rehabilitation Services

描述(申请人提供)：随着人口老龄化，如果主要慢性病的年龄段患病率保持不变，到2049年，美国有功能障碍的人数将增加300%以上。虽然医疗干预有时可以极大地改善身体功能，但恢复功能对许多人来说是不现实的。重点转移到保护功能、减缓其衰退和防止继发性并发症上。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，因为它们在美国的社区中经常使用。该项目将使用对65岁以上和65岁以下的联邦医疗保险受益人的纵向全国性调查(1994-2001年联邦医疗保险当前受益人调查)，与受访者的联邦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，它收紧了康复服务的支付--将作为获得常规康复护理受到限制的条件的“自然实验”。这项拟议的研究旨在考察PT和OT服务强度与良好结果可能性之间的关系，包括以下方面的较低发生率：自我报告的功能下降；总体健康状况恶化；日常生活能力(ADL)和工具性ADL依赖；住院；急性护理住院；受伤提示医疗；卧底溃疡发展；购买辅助技术；社会隔离；以及死亡。这项研究将检查五种情况下的人：关节炎、中风、急性心肌梗死、慢性阻塞性肺疾病和下肢活动障碍，无论原因如何。两个相互关联的假设将指导这项工作：(1)PT和OT强度的增加与较好的结果相关；(2)获得PT和OT的机会减少与较差的结果相关。这些假设将使用横截面和纵向分析进行检验；分析技术将包括时间序列、倾向得分、工具变量和比例风险回归建模。拟议研究的主要结果将是对PT和OT的相关性进行评估，这是全国范围内的常规做法，也是护理的重要结果。

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.