Inpatient Rehabilitation Outcomes in Medicare Hip Fracture Patients

描述(由申请人提供)：到目前为止，基于轶事报告的政策指令，推动利用和治疗决定。尽管医疗保险和医疗补助服务中心(CMS)认为髋部骨折是住院康复机构(IRF)护理的医学上合适的诊断，但几乎没有证据支持这一假设。在现有证据稀少的基础上，该项目的总体目标是确定哪些客户和系统特征能够改善康复结果。将使用两个大型国家数据集-CMS住院康复机构-患者评估工具(IRF-PAI)和服务提供者(POS)文件构建分析文件，以测试可能解释两个时间点(入院和出院)康复结果差异的因素的回归模型。以Andersen的卫生服务使用模型为概念框架，本研究旨在：(1)确定个人特征(易感：年龄、性别、种族)、(使能：社会支持)、(需要：入院时的功能状态和认知状态、以及合并症)对医保受益人髋部骨折患者的康复结果(运动功能、功能状态和出院家庭)的影响；以及(2)确定背景特征(类型、大小、位置、所有权和护士配备)对IRF总体康复结果(运动功能、功能状态和出院家庭)的影响，控制在IRF中患有髋部骨折的医疗保险受益人的总体个人特征(诱因、使能和需求)的影响。这项研究将为政策辩论提供信息，说明哪些类型的患者最适合接受独立的康复治疗，并将根据与髋部骨折患者和弱势群体(即种族/族裔少数群体、没有足够社会支持的老年人和85岁及以上的老年人)的康复结果相关的具体个人和背景特征，确定独立治疗框架在提供康复治疗方面的有效性。特别令人关切的是确定证据基础，以表明这种有效性将在种族/族裔少数群体中产生积极结果。鉴于国家对健康差距的日益关注，确定基于种族/族裔的结果是否存在差异变得越来越重要。健康差距仍然是国家护理研究所(NINR)的一个主要研究重点。拟议的研究和随后的分析将通过确定更好地为旨在消除种族/民族差异的干预措施提供信息的特征，增加目前的护理知识体系。

DESCRIPTION (provided by applicant): To date, policy directives based on anecdotal reports, drive utilization and treatment decisions. Although hip fracture is considered by Center for Medicare and Medicaid Services (CMS) as a medically appropriate diagnosis for Inpatient Rehabilitation Facility (IRF) care, little evidence is available to support this assumption. Building on sparse existing evidence, the overall objective of this project is to determine which client and system characteristics result in improved rehabilitation outcomes. An analytic file using two large national datasets, the CMS Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) and the Provider of Service (POS) file, will be constructed to test regression models of factors that may explain differences in rehabilitation outcomes between two time points, admission and discharge from IRFs. Using the Andersen's Model for Health Services Use as the conceptual framework, the proposed longitudinal study aims to: (1) determine the influence of individual characteristics (Predisposing: age, gender, race), (Enabling: social support), (Need: functional status and cognitive status on admission, and comorbidities) on rehabilitation outcomes (motor functioning, functional status and discharged home) for Medicare beneficiaries with hip fracture in IRFs; and (2) determine the influence of contextual characteristics (type, size, location, ownership and nurse staffing) on IRF aggregate rehabilitation outcomes (motor functioning, functional status, and discharge home), controlling for the influence of aggregate individual characteristics (Predisposing, Enabling and Need) of Medicare beneficiaries with hip fracture in IRFs. This study will inform the policy debate on which types of patients are most appropriate for IRFs and will determine the effectiveness of IRFs in delivering rehabilitative treatment based on specific individual and contextual characteristics associated with rehabilitative outcomes among hip fracture patients and vulnerable subgroups (i.e., racial/ethnic minorities, older adults without adequate social support and those 85 years and older). Of particular concern is determining the evidence base to indicate that such effectiveness will result in positive outcomes among racial/ethnic minorities. Given the growing national interest in health disparities, it becomes increasingly important to determine if there are differences in outcomes based on race/ethnicity. Health disparities remain a major research focus of the National Institute of Nursing Research (NINR). The proposed research and subsequent analysis will add to the current body of nursing knowledge by identifying characteristics that better inform interventions that look to eliminate racial/ethnic disparities.