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）：概念联系和新兴文献表明，家庭护理安排对残疾老年人使用医疗服务有影响。更大的护理网络、无偿帮助的存在、护理人员负担的降低和奖励水平的提高，以及日常生活活动中不存在未满足的需求，以前都与理想的健康结果和永久进入疗养院的可能性较低有关。收件人。在这里，我们通过假设家庭护理安排的这些属性表明了可动员的可用资源的深度来扩展这一调查线，这些资源可以用来帮助接受者进行个人护理以及必要的医疗护理。拟议的项目研究了家庭护理安排的这些属性与医院结果之间的关系，这些属性被认为对家庭护理人员促进适当医疗护理的能力特别敏感。这项前瞻性队列研究利用了 1999 年全国长期护理调查、其随附的护理人员调查以及 1999 年调查完成后 12 个月期间的医疗保险索赔数据的数据。家庭护理安排和住院结果（特别是潜在可预防的住院治疗、重复住院和延迟出院）之间的关系将使用多元回归模型进行估计，该模型控制已知与感兴趣结果相关的个人和护理人员特征，特别关注患者的发病率和疾病的严重程度。拟议的研究将提供对家庭护理人员在一个重要领域的影响的理解，该影响超出了通常归因于他们的结果范围。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。该试点项目的结果将为测量和数据收集工作以及对马里兰州巴尔的摩预计于 2006 年 7 月开始的多部分护理人员干预结果的解释提供信息。