Resource Use and Patient Outcomes in Medicare Home Care

描述（由申请人提供）：临床和行政职位的护士在设计和向医疗保险患者提供家庭护理服务方面发挥着关键作用。今天的医疗保险家庭护理报销由预期支付系统（PPS）管理，医疗保险家庭护理的质量越来越关注通过新的基于结果的质量改进（OBQI）计划最大限度地提高患者的结果。然而，在医疗保险PPS时代，帮助医疗保险家庭护理决策者的证据仍然很少。此外，我们对家庭护理入院时导致不良结局的患者水平风险因素知之甚少，这些因素包括住院治疗、家庭护理出院时的功能障碍以及家庭护理出院时的临床症状频率和严重程度。迄今为止，我们基于俄亥俄州1,284名医疗保险家庭护理患者的初步NINR资助研究（R 01 NR 05081）的结果已经提供了证据，以告知这些知识差距。在这个应用程序中，我们建议直接建立在我们的初步研究中使用的数据，从全国代表性的样本医疗保险家庭护理患者在PPS时代。我们将使用与Medicare索赔数据相关联的结果评估信息集数据来实现以下特定目标：（1）确定由于住院而结束Medicare家庭护理事件的最重要的患者水平风险因素，考虑家庭护理机构因素和县级市场因素的潜在影响;（2）确定出院后留在家中的患者中最重要的患者水平风险因素，以确定家庭护理机构因素和县级市场因素的潜在影响;（3）确定工作人员特定的资源使用措施如何与出院后留在家中的患者的功能障碍和临床症状相关，考虑患者层面的风险因素，家庭护理机构因素和县级市场因素的影响;（4）确定住院模式和预测因素、功能和临床结局以及工作人员特定资源使用，在同一家庭健康资源组（HHRG）内分组的患者中。HHRG用于计算根据Medicare PPS向机构支付的款项。患者层面的风险因素将根据卫生服务使用和结果的Andersen模型进行组织。患者结局指标将包括住院、功能障碍、限制活动的疼痛频率和呼吸困难严重程度。资源使用措施将包括护士，康复治疗师和其他临床工作人员进行家访的数量和强度。结果将有助于在PPS和OBQI时代为医疗保险家庭护理机构的决策者提供有用的科学证据。

DESCRIPTION (provided by applicant): Nurses in clinical and administrative positions play critical roles in the design and delivery of home care services to Medicare patients. Medicare home care reimbursement today is governed by a prospective payment system (PPS), and quality of Medicare home care is increasingly focused on maximizing patient outcomes through the new Outcomes Based Quality Improvement (OBQI) initiative. Evidence to assist Medicare home care decision makers, however, remains sparse regarding actual staff resource use patterns in the Medicare PPS era. Moreover, little is known about patient-level risk factors at home care admission that lead to unfavorable outcomes including hospitalization, functional disability at home care discharge, and clinical symptom frequency and severity at home care discharge. Results to date from our initial NINR-funded study (R01 NR05081), based on 1,284 Medicare home care patients in Ohio, have yielded evidence to inform these knowledge gaps. In this application, we propose to build directly on our initial study by using data from a nationally representative sample of Medicare home care patients in the PPS era. We will use Outcome Assessment Information Set data linked to Medicare claims data to achieve the following specific aims: (1) To determine the most important patient-level risk factors for ending an episode of Medicare home care due to hospitalization, accounting for potential effects of home care agency factors and county-level market factors; (2) To determine the most important patient-level risk factors for greater functional disability and clinical symptoms among patients remaining at home after discharge, accounting for potential effects of home care agency factors and county-level market factors; (3) To determine how staff-specific resource use measures are associated with functional disability and clinical symptoms among patients remaining at home after discharge, accounting for the effects of patient-level risk factors, home care agency factors, and county-level market factors; (4) To determine patterns and predictors of hospitalization, functional and clinical outcomes, and staff-specific resource use, among patients grouped within the same Home Health Resource Groups (HHRGs). HHRGs are used to calculate payments to agencies under Medicare PPS. Patient-level risk factors will be organized according to the Andersen model of health services use and outcomes. Patient outcome measures will include hospitalization, functional disability, pain frequency limiting activity, and dyspnea severity. Resource use measures will include amount and intensity of home visits made by nurses, rehabilitation therapists, and other clinical staff. Results will help provide useful scientific evidence to Medicare home care agency decision makers in the PPS and OBQI eras.