Do Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations Impact End-of-Life Quality and Cost of Care?

项目摘要/摘要 这是K01导师研究科学家发展奖提交给国家 老龄化研究所，罗伯特·泰勒·布劳恩，人口健康科学系讲师 在威尔·康奈尔医学院(WCMC)。布劳恩博士的职业目标是成为一名独立的 研究人员通过评估各种政策干预和改善老年人临终关怀 临终关怀的提供模式。这份K01申请表将为布劳恩博士提供必要的培训 1)获得老龄和临终关怀研究方面的专业知识；2)了解临终关怀患者的临床护理； 以及3)获得方法技能，以进行与临终关怀提供和护理相关的定性研究。 布劳恩博士组建了一个由来自WCMS的有成就的研究人员组成的指导团队 范德比尔特大学医学院(VUSM)：Lawrence Casalino博士(主要导师) 利文斯顿·法兰德是WCMC的公共卫生教授，也是医疗保健组织和 行为和定性方法；欧文·舍伍德·莱特家族的霍莉·普里格森博士(共同导师) WCMC老年病学教授和临终关怀专家；David Stevenson博士(共同导师) 是VUMC的教授和卫生政策教育捐赠董事职位的持有者， 提供临终关怀方面的专家；Mark Unruh博士(共同导师)，他是 WCMC人口健康科学部拥有长期护理和医疗保险方面的专业知识 索赔数据。 在过去的几十年里，临终关怀行业已经从一个主要是非盈利的行业 以盈利为主的部门。由相对容易的市场进入和慷慨的医疗保险推动 Payments、私募股权公司和PTC一直在收购临终关怀机构(其中许多是非营利性的)，目标是 为投资者提供高于市场的短期回报。尽管出现了这种情况，但人们对其知之甚少 对临终关怀的影响。基于他之前关于评估这一现象的研究和培训， 医生实践，布劳恩博士将确定组织，人员配置，病人和质量 使用来自Center的可公开获得的临终关怀数据与PE和PTC收购相关的特征 对于联邦医疗保险和医疗补助服务(CMS)(目标1)，使用严格的计量经济学方法评估 使用患者级别的医疗保险索赔(目标2)和使用 评估收购后临终关怀的组织、文化和交付方面的定性方法 整合(目标3)。这项研究将成为R01赠款申请的基础，并将包括 通过他的培训获得的新技能，为临终关怀的改进提供了机会 提供护理服务。

PROJECT SUMMARY/ABSTRACT This is a K01 Mentored Research Scientist Development Award submitted to the National Institute on Aging by Robert Tyler Braun, an Instructor in the Department of Population Health Sciences at Weill Cornell Medical College (WCMC). Dr. Braun's career goal is to become an independent researcher on improving end-of-life care for the elderly by assessing various policy interventions and delivery models of hospice care. This K01 application will provide Dr. Braun with the necessary training 1) to gain expertise in aging and hospice research; 2) to understand clinical care for hospice patients; and 3) to gain methodological skills to conduct qualitative studies related to hospice delivery and care. Dr. Braun has assembled a mentor team of accomplished researchers from WCMS and Vanderbilt University School of Medicine (VUSM): Dr. Lawrence Casalino (primary mentor) who is the Livingston Farrand Professor of Public Health at WCMC and an expert on health care organization and behavior, and qualitative methods; Dr. Holly Prigerson (co-mentor) who is the Irving Sherwood Wrights Professor of Geriatrics at WCMC and an expert on end-of-life care; Dr. David Stevenson (co-mentor) who is a professor and the holder of the Endowed Directorship in Health Policy Education at VUMC and an expert in the delivery of hospice care; and Dr. Mark Unruh (co-mentor) who is an Associate Professor in the Department of Population Health Sciences at WCMC with expertise in long-term care and Medicare claims data. Over the past couple of decades, the hospice industry has moved from largely a not-for-profit sector to predominately for-profit. Facilitated by relatively easy market entry and generous Medicare payments, PE firms and PTCs have been acquiring hospices (many of them non-profit), with the goal to deliver short-term, above market returns to their investors. Despite this emergence, little is known of its effect on hospice care. Building on his previous research and training on assessing this phenomenon in physician practices, Dr. Braun will identify the organizational, staffing, patient, and quality characteristics associated with PE and PTC acquisitions using publicly available hospice data from Center for Medicare and Medicaid Services (CMS) (Aim 1), use rigorous econometric methods to assess the effect PE and PTC acquisition on hospice care using patient-level Medicare claims (Aim 2), and use qualitative methods to assess organizational, cultural, and delivery aspects of hospices post-acquisition integration (Aim 3). This research will be a foundation for an R01 grant application and will incorporate the new skills acquired through his training, which inform opportunities for improvement in hospice delivery of care.