Which Post-Acute Care Setting is Best for Patients' Outcomes?

项目总结 在过去的十年中，急性后护理(PAC)的使用经历了快速增长。不幸的是，有 缺乏对替代政治行动委员会服务的相对有效性和质量的了解 做出明智的临床和政策决策。造成这一知识差距的因素包括 PAC设置的多样性(每个设置都有自己的一套监管和支付激励措施、自己的待遇 方法，以及自己的患者评估工具)，以及患者对特定反应的异质性 阻碍跨环境比较的治疗方法。首要目标是检查PAC利用率和 不同条件和PAC环境下的患者结局，以解决知识中的重要差距 阻碍根据《平价医疗法案》(ACA)进行的当前政策努力的设计，类似于基于情节的 捆绑付款和创建负责任的关怀组织，旨在提高 急诊后护理。追求这一目标的目标是进行一项比较成本效率研究，以确定 哪种PAC设置(单独设置或与其他设置组合)可提供最佳结果，以及与哪种设置相关 患者、市场和提供者因素对背景和结果的选择的重要性。我们的基础 假设是，在具有更多不同PAC设置的PAC市场中，专业化会导致改进 结果(至少对于一些患者亚组)，但它促进了护理的中断，从而导致 利用率。拟议的研究将把医疗保险索赔数据与SNF、IRF和HHA的评估数据联系起来 2007-2016十年期间，检查总体PAC结果和患有五种示踪剂疾病的患者： 髋部骨折、下肢关节置换、充血性心力衰竭、慢性阻塞性肺疾病和中风。我们的预期结果是 建议的目标是更深入地了解可用性、市场和提供商特征对PAC的影响 使用模式和患者结果。这种知识有可能为现在和未来提供信息。 PAC政策旨在减少/控制总体PAC成本，而不会对结果产生负面影响。

PROJECT SUMMARY Over the last decade, the use of post-acute care (PAC) has experienced a rapid growth. Unfortunately, there is a paucity of knowledge about the comparative effectiveness and quality of alternative PAC services needed to make informed clinical and policy decisions. Factors that contribute to this gap in knowledge include the diversity in PAC settings (each with its own set of regulatory and payment incentives, its own treatment approach, and its own patient assessment tool), and heterogeneity in the response of patients to specific treatments that hinder comparisons across settings. The overarching goal is to examine PAC utilization and patient outcomes across different conditions and PAC settings to address important gaps in knowledge that hinder the design of current policy efforts undertaken under the Affordable Care Act (ACA) like episode-based bundling of payments and the creation of Accountable Care Organizations, aimed at improving the value of post-acute care. The objective in pursuit of this goal is to do a comparative cost efficiency study to determine what PAC setting (in isolation or combined with others) delivers the best outcomes, and to what is the relative importance of patient, market and provider factors on the election of setting and the outcomes. Our underlying hypothesis is that specialization in PAC markets with a larger variety of PAC settings leads to improved outcomes (at least for some patient subgroups) but it promotes discontinuities of care that lead to increased utilization. The proposed study will link Medicare claims data and SNF, IRF and HHA assessment data across the 2007-2016 ten-year period to examine PAC outcomes overall and for patients with five tracer conditions: hip fracture, lower extremity joint replacement, CHF, COPD, and stroke. The expected outcomes of our proposed aims are a deeper understanding of how availability, market and provider characteristics impact PAC utilization patterns and patient outcomes. This knowledge has the potential for informing current and future PAC policies intended to reduce/contain overall PAC costs without negatively impacting outcomes.