Leveraging Medicare Payment & Reporting Policies to Improve Nursing Home Quality

描述（由申请人提供）：从历史上看，养老院主要为长期住院的慢性病患者提供监护服务。然而，一系列政策变化极大地扩大了急性期后的医疗保险融资市场。医疗保险和医疗补助服务中心还推出了一项全国养老院报告卡倡议，旨在利用市场激励来改善部门绩效。医疗保险进入这个市场提供了一个机会，以解决长期存在的问题，低质量的慢性护理养老院人口。尽管慢性和急性后疗养院人口的需求存在重大差异，但设施内的护理质量具有所有居民共享的公共产品的特征。这一观察的中心含义是，旨在改善医疗保险居民护理的医疗保险资源和政策可能会溢出到其他居民。该项目开发并应用了一个框架，用于评估医疗保险日益参与该市场的影响。提出了以下具体目标：利用1996-2005年期间全国机构级在线调查、认证和报告（OSCAR）数据，量化医疗保险支付政策和报告卡对急性医疗保险养老院使用率和疾病严重程度的影响。2. 使用1999-2005年国家最低数据集评估和使用OSCAR数据的监管缺陷和人员配置，量化医疗保险支付政策和报告卡对急性后和监护质量指标（如约束使用；压疮）的影响。3. 应用目标1和目标2的研究结果，得出与医疗保险支付和质量报告政策相关的关键政策权衡。利用5个州的设施级微观模拟分析，通过其支付和报告政策表征医疗保险对医疗保险和其他居民质量的影响。意义：通过研究急症后医疗保险养老院政策与监护养老院人口护理结果之间的联系，本研究为数百万在养老院接受护理的美国人提供了一个提高护理质量的机会。本研究也将为养老院研究者提供一个新的框架来共同分析急性病后与慢性病后养老院服务的提供。因此，本研究所得的资讯有可能为改善所有养老院居民的照护品质，做出重要的研究和政策相关贡献。

DESCRIPTION (provided by applicant): Historically, nursing homes predominantly provided custodial care to a long-stay, chronically ill population. However, a series of policy changes greatly expanded the post-acute, Medicare-financed side of the market. The Centers for Medicare & Medicaid Services also introduced a national nursing home report card initiative with the intention of using market incentives to improve sector performance. Medicare's entry into this market presents an opportunity to address the long-standing issue of low quality among the chronic care nursing home population. Despite important differences in the needs of chronic and post-acute nursing home populations, quality of care within a facility has characteristics of a public good shared across all residents. The central implication of this observation is that Medicare resources and policies directed at improving care for Medicare residents may spillover to other residents. This project develops and applies a framework for evaluating the implications of Medicare's increasing involvement in this market. The following specific aims are proposed: 1. To quantify the impact of Medicare payment policy and report card efforts on post-acute Medicare nursing home utilization and illness severity using national facility-level Online Survey, Certification and Reporting (OSCAR) data for the period 1996-2005. 2. To quantify the impact of Medicare payment policy and report card efforts on post-acute and custodial quality indicators (e.g., restraint use; pressure ulcers) using national 1999-2005 Minimum Data Set assessments and regulatory deficiencies and staffing using the OSCAR data. 3. To apply the findings from Aims 1 and 2 to derive key policy tradeoffs related to Medicare payment and quality reporting policies. Using facility-level microsimulation analyses in 5 states, characterize Medicare's influence on quality for Medicare and other residents through its payment and reporting policies. Significance: By examining the link between post-acute Medicare nursing home policy and outcomes of care for the custodial nursing home population, this study provides an opportunity to improve the quality of care for the millions of Americans receiving care in the nursing home setting. This study will also provide nursing home researchers with a new framework for jointly analyzing the provision of post-acute and chronic nursing home services. Thus, the information derived from this study has the potential to make important research and policy-relevant contributions aimed at improving the quality of care for all nursing home residents.