Health Care Use After Functional Disability: Opportunities to Improve the Care of Older Adults

项目总结/摘要 功能性残疾深刻地影响着老年人的健康和医疗保健使用， 没有得到卫生系统的持续监测，也没有被医疗保险定期收集。患者及其家属 这些未被承认的需求往往得不到充分的支持。某些疾病或 传统上，多弹头导弹一直是研究的重点，研究的重点是高的和潜在的负担 医疗保健使用，残疾，定义为需要帮助进行日常生活活动（ADL），可能是一个更 关键的和普遍的因素。残疾和医疗保健使用之间的关系是复杂的： 条件可能导致残疾和医疗保健使用，残疾和未满足的护理需求可能导致健康 护理使用和住院本身可能导致残疾。保健系统的特点和做法各不相同 模式，如医院病床数量和当地医疗保健强度水平，影响护理模式， 区域一级，并可能影响残疾和医疗保健使用之间的关系。全国范围内 医疗保险优势（MA）计划正在迅速扩大，并提供越来越多的灵活性，在补充 这些福利可以更好地支持残疾老年人。然而，患有功能性残疾的老年人 更有可能离开MA计划，并可能从质量较低的专业护理机构和家庭保健机构接受护理 机构在MA。目前尚不清楚MA计划是否正在将护理从设施转移到社区和无偿 护理人员，以降低成本。Paul Beeson Emerging Leaders职业发展奖 我将支持我的努力，通过研究来解决这一差距，研究残疾与 以及三个层面的医疗保健使用：个人、卫生系统和卫生政策。在SA1中，我将调查 首次报告使用Medicare的ADL残疾后，医疗保健使用的个人水平异质性 与索赔相关的国家健康和老龄化趋势研究（NHATS），该研究允许确定 残疾发作。在SA2中，我将使用健康和退休研究以及捕捉区域特征的数据 评估区域卫生系统特征对残疾后卫生保健利用的影响。在SA3中，我将使用 NHATS与医疗保险数据相关联，以检查护理环境的差异（即，社区与机构护理） 和双折射（即，有偿和无偿服务）之间的老年人与功能性残疾的MA与 传统医疗这些科学目标与一项全面的发展计划密切相关， 将获得先进的方法学专业知识，在轨迹分析和分层建模，临床和 系统理解老年残疾，卫生经济学和政策洞察力，以及领导技能， 将我的发现转化为政策变化。这个为期五年的项目利用了我丰富的经验， 基于调查的研究，我所在机构的资源，以及我导师的专业知识， 有机会改善老年人的护理，同时促进我作为一个独立的发展 研究人员致力于改善老年人功能性残疾的医疗保险政策。

PROJECT SUMMARY/ABSTRACT Functional disability profoundly impacts the health and health care use of older adults, and yet functional status is not consistently monitored by health systems, nor routinely collected by Medicare. Patients and their families frequently struggle with inadequate support for these unrecognized needs. While specific diseases or multimorbidity have traditionally been the focus of research investigating high and potentially burdensome health care use, disability, defined as needing help performing activities of daily living (ADLs), may be a more critical and universal factor. The relationship between disability and health care use is complex: medical conditions may result in both disability and health care use, disability and unmet care needs can lead to health care use, and hospitalization itself can cause disability. Variation in health system features and practice patterns, such as the numbers of hospital beds and local levels of health care intensity, impact care patterns at a regional level and may influence the relationship between disability and health care use. Nationally, the Medicare Advantage (MA) program is rapidly expanding and offers increasing flexibility in supplemental benefits that could better support older adults with disability. However, older adults with functional disability are more likely leave MA plans and may receive care from lower quality skilled nursing facilities and home health agencies in MA. It is unknown if MA plans are shifting care from facilities to the community and to unpaid caregivers in order to reduce costs. The Paul Beeson Emerging Leaders Career Development Award in Aging will support my effort to address this gap through research that will examine the relationship between disability and health care use at three levels: the individual, health system, and health policy. In SA1, I will investigate the individual-level heterogeneity of health care use after the first report of ADL disability using the Medicare claims-linked National Health and Aging Trends Study (NHATS), which allows for identification of the month of disability onset. In SA2, I will use the Health and Retirement Study and data capturing regional characteristics to assess the influence of regional health system features on health care use after disability. In SA3, I will use NHATS linked to Medicare data to examine differences in care setting (i.e., community vs. institutional care) and caregiving (i.e., paid and unpaid caregiving) between older adults with functional disability in MA vs. traditional Medicare. These scientific aims link closely with a comprehensive development plan through which I will gain advanced methodological expertise in trajectory analysis and hierarchical modeling, clinical and systems understanding in geriatric disability, health economics and policy insight, and the leadership skills to translate my findings to policy change. This five-year project leverages my extensive experience conducting survey-based research, the resources of my institution, and the expertise of my mentors to identify opportunities to improve the care of older adults while catalyzing my development as an independent researcher working to improve Medicare policy for older adults with functional disability.