Understanding Variations in Hip Fracture Outcomes across the Continuum of Care

描述（由申请人提供）：急性和急性后护理机构提供的护理变化在多大程度上有助于急性内科和外科疾病老年人的长期生存和功能恢复？这个问题对于理解老年人的医疗保健和结果之间的关系至关重要，具有深刻的政策含义。拟议的提供系统改革，如负责任的护理组织和捆绑支付，侧重于治疗的最终结果，而不是在任何特定环境中提供的服务数量，作为确定医疗保健支付的适当基础。因此，了解卫生保健系统的离散组件现在在多大程度上有助于患者结果的变化是至关重要的有效设计，实施和评估这些政策战略。我的项目将增加目前的知识，如何在美国医疗保健系统的两个不同的组成部分，急性和急性后护理设施内提供的护理的变化，每一个都有助于观察到的模式的结果与急性疾病的老年人。要做到这一点，它将重点关注老年人髋部骨折的护理和结果，这是一种高度病态的疾病，每年影响超过30万美国老年人。采取混合方法，它将纳入一项全国性的髋部骨折患者回顾性队列研究，以及一系列与医疗保健提供者和管理人员的定性访谈，以：1）测量特定的急性和急性后护理设施因素与髋部骨折后6个月生存率和功能恢复的相关性~ 2）比较急性与急性后护理设施因素的相对影响，急性护理设施因素对髋部骨折后6个月生存和功能恢复的影响~和3） 描述在一系列急性和急性后护理机构中，髋部骨折护理机构方法的质的差异。通过这门课程的研究，我的项目将提供对髋部骨折结果变化的程度和原因的新见解，并作为一个模型，用于了解影响老年人的各种医疗和手术条件下健康结果的系统性决定因素。沿着指导和研究培训的结构化课程，这个项目将为我提供实现我的职业目标所需的技能和经验，成为一名领先的老龄化研究人员，致力于改善护理系统和在美国接受住院和手术的老年人的结果。 公共卫生相关性：本项目研究了在急性护理（医院）设施和急性后护理（护理）设施中接受髋部骨折治疗的患者的生存和功能结局的系统性变化的程度和原因。 它将定义预测改善髋部骨折结局的特定急性和急性后护理设施因素，比较急性与急性后护理设施因素对髋部骨折总体变化的相对贡献。 骨折结局，并描述机构实践的定性差异，以解释急性和急性后设施结局的差异。通过这样做，该项目将提供 新的见解的重要性的设计，实施和评估的政策战略，旨在提高急性和急性后护理服务的髋部骨折的质量，并将提供一个模型，了解医疗保健设施因素的作用，在确定护理结果的老年美国成年人接受住院治疗和手术的一系列急性条件。

DESCRIPTION (provided by applicant): To what extent do variations in the care delivered at acute and post-acute care facilities contribute to current patterns of long-term survival and functional recovery for older adults with acute medical and surgical conditions? This question, which is fundamental to understanding the relationship between medical care and outcomes for older adults, carries profound policy implications. Proposed delivery-system reforms, such as accountable care organizations and bundled payments, focus on the end results of treatment, rather than the quantity of services provided in any given setting, as the proper basis for determining health care payments. As a result, knowing the extent to which discrete components of the health care system now contribute to variations in patient outcomes is vital to the effective design, implementation and evaluation of these policy strategies. My project will add to current knowledge as to how variations in the care delivered within two distinct components of the U.S. health care system-acute and post-acute care facilities-each contribute to observed patterns of outcomes among older adults with acute illnesses. To do so, it will focus on the care and outcomes of older adults with hip fracture, a highly morbid condition that affects over 300,000 older U.S. adults each year. Taking a mixed-methods approach, it will incorporate a national retrospective cohort study of hip fracture patients and a series of qualitative interviews with health care providers and administrators to: 1) measure the association of specific acute and post-acute care facility factors with 6-month survival and functional recovery after hip fracture~ 2) compare the relative influence of acute versus post-acute care facility factors on 6-month survival and functional recovery after hip fracture~ and 3) characterize qualitative differences in institutional approaches to hip fracture care across a range of acute and post-acute care facilities. Through this course of research, my project will offer new insights into the extent and causes of variations in hip fracture outcomes and serve as a model for understanding the systemic determinants of health outcomes across a broad range of medical and surgical conditions affecting older adults. Along with a structured course of mentoring and research training, this project will provide me with the skills and experiences needed to reach my career goal of becoming a leading researcher in aging dedicated to improving systems of care and outcomes for older adults undergoing hospitalization and surgery in the U.S. PUBLIC HEALTH RELEVANCE: This project examines the extent and causes of systematic variations in survival and functional outcomes among patients treated for hip fracture in acute care (hospital) facilities and post-acute care (nursing) facilities. It will define the specific aute and post-acute care facility factors that predict improved hip fracture outcomes compare the relative contribution of acute versus post-acute care facility factors to overall variations in hip fracture outcomes, and characterize qualitative differences in institutional practices to explain variations in outcomes across acute and post-acute facilities. In so doing, this project will offer new insights of importance to the design, implementation, and evaluation of policy strategies intended to improve the quality of acute and post-acute care services for hip fracture, and will offer a model for understanding the role of health care facility factors in determining the outcomes of care for older U.S. adults undergoing hospitalization and surgery for a range of acute conditions.