Skilled Nursing Facility Participation in Health Information Exchange and Quality of Care for Patients with Alzheimer's Disease and Related Dementias

项目摘要/摘要 在联邦医疗保险费用中，每年有150万个熟练护理设施(SNF)住宿用于急性后护理- 阿尔茨海默病或相关痴呆症服务受益人(ADRD)，占 在SNF中接受护理的受益人。ADRD患者经常面临独特的挑战，包括无法 描述他们的诊断和症状，或参与护理计划，这可能有助于更高的 住院和预后不佳后使用三氟化钠的可能性。住院后，ADRD患者 与没有ADRD的患者相比，SNF出院的可能性高出四倍。患有SNF的患者 ADRD患者的预后比其他SNF患者更差，包括更高的再住院率，更长的SNF 留下来，被释放回社区的可能性较低。信息共享不足 SNF、医院和其他提供者之间的能力被认为是导致 这些事件。SNF没有资格通过Medicare和Medicaid EHR获得奖励付款 激励计划导致医院和医院广泛采用医疗信息技术 医生。政策制定者现在正在积极促进HIE的参与，以此作为提高质量的手段 在SNF中的护理。然而，没有证据表明它能够对患有ADRD的SNF患者做到这一点。这很有可能 由于缺乏关于SNF参与HIE的现有数据，其中包括关键信息，如HIE的日期 参与。在这个项目中，将使用一种新的数据源，其中包括所有人参加HIE的日期 在八年期间(2012-2019年)在纽约州参加HIE的国家工作队。这些数据将被合并 拥有该州所有在SNF期间接受护理的受益人的100%联邦医疗保险索赔样本 研究期间检查新生儿缺氧缺血性脑病中神经营养因子的参与与护理质量和费用的关系 适用于ADRD患者。SNF参与HIE和护理质量之间的关系也将是 专门为符合双重资格的人和患有ADRD的少数族裔接受检查，他们更有可能获得 与其他医疗保险受益人相比，分散的医疗服务质量较低。我们的研究设计利用了 使用SNF参与HIE的不同时间的差异-差异框架，并结合了 基于患者住所和最近的SNF之间的差别距离的辅助变量 有HIE和最近的无HIE的SNF。稳健的研究设计将允许估计强烈指示 因果关系。无论我们的调查结果如何，拟议项目的结果都将是重要的。这将是第一次 社区卫生服务人员参与HIE是否(1)提高了保健质量，(2)降低了保健 减少成本，或(3)减少收入和ADRD患者护理质量方面的种族差异。这些信息将会 对政策制定者、SNF和医院高管、医生、患者和健康信息领导者有用 交流。

PROJECT SUMMARY/ABSTRACT Each year there are 1.5 million skilled nursing facility (SNF) stays for post-acute care among Medicare fee-for- service beneficiaries with Alzheimer’s disease or related dementias (ADRD), representing over 60% of beneficiaries who receive care in SNFs. ADRD patients often face unique challenges, including an inability to describe their diagnoses and symptoms or to participate in care planning, which may contribute to a higher likelihood of SNF use following hospitalization and poor outcomes. Following hospitalization, ADRD patients are four times more likely to be discharged to a SNF compared to patients without ADRD. SNF patients with ADRD have worse outcomes than other SNF patients, including higher re-hospitalization rates, longer SNF stays, and a lower likelihood of being discharged back to the community. Insufficient information-sharing capabilities between the SNF, the hospital, and other providers are thought to contribute to the frequency of these events. SNFs were not eligible to receive incentive payments through the Medicare and Medicaid EHR Incentive Programs that led to widespread adoption of health information technology among hospitals and physicians. HIE participation is now being actively promoted by policymakers as means to improve the quality of care in SNFs. However, there is no evidence of its ability to do so for SNF patients with ADRD. This is likely due to a lack of available data on SNF participation in HIE that includes key information, such as dates of HIE participation. In this project, a novel data source will be used that includes dates of HIE participation for all SNFs participating in HIE in New York State over an eight-year period (2012-2019). These data will be merged with a 100% sample of Medicare claims for all beneficiaries in the state who received care in SNFs during the study period to examine the relationship between SNF participation in HIE and the quality and the cost of care for patients with ADRD. The relationship between SNF participation in HIE and the quality of care will also be examined specifically for dual-eligibles and racial minorities with ADRD, who are more likely to receive fragmented care of lower quality compared to other Medicare beneficiaries. Our research design utilizes a difference-in-differences framework using the differential timing of SNF participation in HIE and incorporates an instrumental variable based on a patient’s residence and the differential distance between the nearest SNF with HIE and the nearest SNF without HIE. The robust study design will allow estimation strongly indicative of causation. The results of the proposed project will be important regardless of our findings. It will be the first investigation of whether HIE participation among SNFs (1) improves the quality of care, (2) lowers health care costs, or (3) reduces income and racial disparities in the quality of care for ADRD patients. The information will be useful to policymakers, SNF and hospital executives, physicians, patients, and leaders of health information exchanges.