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在多大程度上影响了患有急性内科和外科疾病的老年人的长期生存和功能恢复的当前模式？这个问题是理解老年人医疗保健与结果之间关系的基础，具有深远的政策意义。拟议的服务系统改革，如问责制保健组织和捆绑付款，将重点放在治疗的最终结果上，而不是在任何特定环境中提供的服务数量，以此作为确定保健付款的适当基础。因此，了解卫生保健系统的离散组成部分现在对患者结果变化的影响程度，对于有效设计、实施和评估这些政策战略至关重要。我的项目将增加现有的知识，即在美国医疗保健系统的两个不同组成部分——急性和急性后护理设施——中提供的护理的变化如何影响观察到的老年人急性疾病的结果模式。为此，它将重点关注髋部骨折老年人的护理和结果，髋部骨折是一种高度病态的疾病，每年影响超过30万美国老年人。该研究采用混合方法，包括对髋部骨折患者进行全国回顾性队列研究，并对卫生保健提供者和管理人员进行一系列定性访谈，以便：1)衡量特定的急性和急性后护理设施因素与髋部骨折后6个月生存和功能恢复的关系~ 2)比较急性和急性后护理设施因素对髋部骨折后6个月生存和功能恢复的相对影响~和3)

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.