In-Home Caregiving and Use of Medical Services

家庭护理和医疗服务的使用

• 批准号: 6983228
• 负责人: Jennifer L. Wolff
• 金额: $ 7.34万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-01 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6983228
• 关键词: Medicare /Medicaid; aging; behavioral /social science research tag; caregivers; clinical research; disabling disease; extended care; functional ability; health care service evaluation; health care service utilization; health services research tag; home health care; hospital utilization; human data; human morbidity; human old age (65+); person with disability

DESCRIPTION (provided by applicant): Conceptual links and a nascent literature suggest that in-home caregiving arrangements have a bearing on disabled older adults' use of medical services. Larger caregiving networks, the presence of unpaid help, lower levels of caregiver burden and higher levels of reward, and the absence of unmet need with activities of daily living have previously been linked to desirable health outcomes and a lower likelihood of permanent nursing home entry for recipients. Here we extend this line of inquiry by hypothesizing that these attributes of in-home caregiving arrangements are indicative of the depth of available resources that may be mobilized to assist recipients with personal care as well as necessary medical care. The proposed project examines the relationship between these attributes of in-home care arrangements and hospital outcomes that are thought to be particularly sensitive to the ability of in-home caregivers to facilitate appropriate medical care. This prospective cohort study draws on data from the 1999 National Long Term Care Survey, its accompanying Caregiver Survey, and Medicare claims data for the 12-month period following completion of the 1999 survey. The relationship between in-home caregiving arrangements and hospitalization outcomes (specifically, potentially preventable hospitalizations, repeat hospital admissions, and delayed discharges) will be estimated using multivariate regression models that control for individual and caregiver characteristics known to be related to the outcomes of interest, with particular attention to patient morbidity and severity of illness. The proposed research will provide an understanding of the influence of in-home caregivers in an important area that is beyond the scope of outcomes typically attributed to them. The ultimate goal of this work is to develop strategies that support caregivers and improve the health of older adults. Findings from this pilot project will inform measurement and data collection efforts, as well as interpretation of results from a multi-component caregiver intervention in Baltimore, Maryland that is expected to begin in July 2006.

描述（由申请人提供）：概念链接和新生的文献表明，内部的护理安排与残疾老年人对医疗服务的使用有关。较大的护理网络，无薪帮助的存在，较低的护理人员负担和更高的奖励水平以及以前的日常生活活动不需要未满足的需求与理想的健康成果以及接收者永久性疗养院进入的可能性较低。在这里，我们通过假设这些内部护理安排的这些属性表明了可用资源的深度来扩展此询问线，这些属性可能被动员起来，以帮助接受者提供个人护理以及必要的医疗服务。拟议的项目研究了这些家庭护理安排的这些属性与医院成果之间的关系，这些属性被认为对内部护理人员促进适当的医疗服务的能力特别敏感。这项前瞻性队列研究借鉴了1999年国家长期护理调查，其随附的护理人员调查以及Medicare索赔数据的数据，该数据在1999年调查完成后的12个月期间的数据。将使用多变量回归模型估算，将估算出家庭护理结构和住院治疗结果之间的关系（具体来说，可能可预防的住院，重复住院和延迟出院），这些模型控制着已知的个人和护理人员特征，这些模型与感兴趣的结果有关，特别注意患者的疾病疾病的疾病疾病的疾病，尤其是对患者的关注。拟议的研究将提供对重要领域中家庭护理人员的影响的理解，该领域超出了通常归因于他们的结果的范围。这项工作的最终目标是制定支持护理人员并改善老年人健康的策略。该试点项目的发现将为测量和数据收集工作提供信息，以及对马里兰州巴尔的摩的多组分护理人员干预的结果解释，预计将于2006年7月开始。