A DETAILED PROFILE OF THE END-OF-LIFE CARE IN MEDICARE

医疗保险中临终关怀的详细概况

基本信息

批准号：
6337256
负责人：
DORCAS JOANNE LYNN
金额：
$ 31.39万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
1999
资助国家：
美国
起止时间：
1999-09-30 至 2002-09-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6337256
关键词：
Medicare /Medicaid chronic obstructive pulmonary disease clinical research congestive heart failure dementia health care cost /financing health care service evaluation health insurance health services research tag human mortality human subject neoplasm /cancer

项目摘要

The objectives of this proposed study are: 1. To document in detail the cost and patterns of end-of-life care for Medicare beneficiaries within five broad categories (cancers, dementia, congestive heart failure, chronic obstructive pulmonary disease, all other deaths). 2. To examine the geographic variations in cost and patterns of care within these categories, and determine the factors associated with variation in cost and patterns of care for these diseases. 3. To demonstrate methods for prospectively identifying cohorts of beneficiaries likely to be nearing end of life, and to calculate prospective capitation rates for these cohorts. The overall goal of this work is to obtain basic research needed to reshape Medicare payment policy for end-of-life care. Medicare's fractured fee-for-service payment discourages integrated management of end stage disease and encourages acute over palliative treatment. Integrated payment approaches (per diem, capitation, or other) have greater potential to encourage delivery of appropriate and compassionate end-of-life care. Restructuring Medicare policy toward more integrated payment requires identifying individuals likely to benefit from special end-of-life care, determining services and providers to be covered under an integrated payment, calculating Medicare's average cost for those services, and analyzing variation around that average cost. The proposed research will provide detailed data needed to discuss options for restructuring Medicare payment for end-of-life care. We propose a combination of descriptive analysis and hypothesis testing. First, because so little detailed information is available, we propose to create a databook on Medicare end-of- life care, a comprehensive profile of cost and use. Descriptive analyses will be guided by a National Advisory Board of experts in end-of-life care, with a goal of developing a useful reference on Medicare-financed end-of-life care. Second, we will test specific hypotheses regarding cost and use.

这项拟议的研究的目标是：1。详细记录五个广泛类别（癌症，痴呆症，充血性心力衰竭，慢性阻塞性肺部疾病，所有其他所有其他死亡）的医疗保险受益人的临终关怀成本和模式。 2。检查这些类别内的成本和护理模式的地理差异，并确定与这些疾病成本和护理模式变化相关的因素。 3。展示前瞻性识别可能接近生命终结的受益人同类人群的方法，并计算这些同类群体的前瞻性人物。这项工作的总体目标是获得重塑医疗保险付款政策所需的基础研究。 Medicare的费用支付付款不鼓励对终阶段疾病的综合管理，并鼓励对姑息治疗进行急性。综合付款方法（按DIEM，人物或其他）具有更大的潜力，可以鼓励提供适当和富有同情心的寿命护理。将Medicare政策重组为更综合的付款需要确定可能从特殊的临终护理中受益的个人，确定服务和提供者在综合付款中涵盖的服务，从而计算Medicare的平均服务成本，并分析该平均成本的变化。拟议的研究将提供讨论重组Medicare付款以进行临终护理的选择所需的详细数据。我们提出了描述性分析和假设检验的组合。首先，由于可用的详细信息很少，因此我们建议创建有关Medicare生命终结的数据库，这是成本和使用的全面概况。描述性分析将由国家临终护理专家顾问委员会指导，其目的是为医疗保险资助的临终关怀提供有用的参考。其次，我们将检验有关成本和使用的特定假设。