Evaluating Policy Solutions Aimed at Improving Hospice Care Access in Rural Areas

评估旨在改善农村地区临终关怀服务的政策解决方案

• 批准号: 10555012
• 负责人: Lauren Gray Gilstrap
• 金额: $ 20.51万
• 依托单位: DARTMOUTH-HITCHCOCK CLINIC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10555012
• 关键词: Address; Area; Caregivers; Caring; Characteristics; Communication; Complex; Eligibility Determination; Enrollment; Grant; Health Services Accessibility; Hospice Care; Individual; Intervention; Interview; Knowledge; Markov chain Monte Carlo methodology; Medicare; Methods; Modeling; Patient Preferences; Patients; Pattern; Perception; Policies; Policy Maker; Population Density; Poverty; Predictive Factor; Provider; Research; Residual state; Rural; Rural Health Centers; Science; Services; Structure; Testing; Time; Travel; United States Centers for Medicare and Medicaid Services; Voluntary Programs; Work; acute care; beneficiary; community partnership; cultural values; end of life; end of life care; health belief; health care delivery; hospice environment; improved; innovation; large datasets; models and simulation; novel; programs; rural area; rural patients; success; urban area

PROJECT SUMMARY/ABSTRACT Project 4 (Gilstrap): Evaluating Policy Solutions Aimed at Improving Hospice Care Access in Rural Areas In 2016, almost 1.5 million Medicare beneficiaries enrolled in hospice and an equal number, if not more, were eligible but chose not to enroll. Hospice can provide a myriad of benefits for patients and caregivers, and has been shown to decrease futile care at the end of life, making under-enrollment a problem. With only 34% of rural decedents enrolled in hospice as compared to the 51% in urban areas, rural under-enrollment contributes to a higher rate of acute care at end of life. In 2016, the Center for Medicare and Medicaid Services (CMS) launched the Medicare Care Choices Model (MCCM). This voluntary program aimed to address the “acceptability,” aspect of hospice access, by allowing patients to enroll in hospice without stopping treatment for their terminal condition. Though early results suggest that the program increased enrollment and decreased spending, it remains unclear how the MCCM program performed in rural areas, what factors predicted success in rural areas, and whether increased demand for services was met by rural hospice agencies. This project will investigate these gaps in knowledge using relevant, timely, and innovative analyses and methods. As the research team works to examine the impact of MCCM in rural areas, determine the residual barriers to hospice expansion in rural areas, and model the estimated impacts of various policy solutions, they will leverage large data sets, novel crosswalks, qualitative interviews, and simulation modeling. The work on this project will ultimately prepare the PI, Dr. Gilstrap, to develop and submit an R01 application with the aim of implementing and testing strategies identified in this grant to quantify their impact on rural hospice enrollment.

项目摘要/摘要 项目4（Gilstrap）：评估旨在改善农村临终关怀访问的政策解决方案 2016年，临终关怀的近150万Medicare受益人（如果没有更多的话）是 符合条件，但选择不注册。临终关怀可为患者和看护人提供无数的利益，并且 我们被证明可以减少生命尽头的徒劳护理，从而使未经货币成为问题。只有34％ 临终关怀的农村死者与城市地区的51％相比，较粗糙的销售不足有所贡献 生命末期的急性护理率更高。 2016年，医疗保险和医疗补助服务中心（CMS） 推出了Medicare Care Choices Model（MCCM）。该志愿计划旨在解决 通过允许患者入学而无需停止治疗的“可接受性”，这是临终关怀访问的方面 对于它们的终端条件。尽管早期结果表明该计划增加了入学率和减少 支出，尚不清楚MCCM计划在粗糙区域的执行方式，该因素预测了什么因素 粗糙的临终关怀机构在粗糙地区的成功以及对服务需求的增加是否满足。 该项目将在知识，及时和创新分析中调查这些差距，并 方法。随着研究小组致力于检查MCCM在粗糙区域的影响，请确定残差 在粗糙地区扩展临终关怀的障碍，并对各种政策解决方案的估计影响进行建模，它们 将利用大型数据集，新颖的人行横道，定性访谈和仿真建模。工作 该项目最终将准备PI Gilstrap博士开发和提交R01申请，目的 在本赠款中确定的实施和测试策略，以量化其对粗糙临终关怀入学的影响。