Effect of home care agency providers and visits of heart failure patient outcomes

家庭护理机构提供者和就诊心力衰竭患者结果的影响

基本信息

批准号：
7385996
负责人：
ELIZABETH A. MADIGAN
金额：
$ 34.61万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-04-01 至 2011-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7385996
关键词：
Acute Adult Age Age-Years Aged, 80 and over American Area Behavioral Model Caring Certification Clinical Data Communities Condition County County Hospitals Data Data Set Databases Ethnic Origin Evaluation Face Health Health Care Visit Health Services Health system Healthcare Systems Heart failure Home Care Agencies Home Care Services Home Health Agency Home Health Care Agencies Home environment Home visitation Hospitalization Hospitals House Call Incidence Individual Length Length of Stay Link Location Long-Term Care Medicare Minority Modeling Nature Numbers Nursing Homes Outcome Outcome Assessment Patient Care Patients Pattern Persons Physicians Population Predictive Factor Provider Purpose Rate Registered nurse Research Resources Risk Rural Sampling Services Source Standards of Weights and Measures Surveys Time Variant Visit Week base care delivery clinical application cost day design follow-up functional decline functional status improved indexing innovation prevent residence size

项目摘要

DESCRIPTION (provided by applicant): Heart failure (HF) is a high burden condition for Americans and the health care system serving them-heart failure is the leading cause of hospitalization for patients over 65 with rates of rehospitalization as high as 65% within 6 months of the index hospital stay. Patients with heart failure also have progressive decline in functional status. Post-acute follow up in the home is one strategy to reduce the burden of heart failure on the US health care system. Home health care agencies are the most common type of post-acute care provider for patients with heart failure. Yet there is little evidence on the most effective ways to reduce rehospitalization and improve functional status outcomes for HF patients receiving home health care. In home health care, little research has been done on the relationship between the numbers of visits and outcomes and the results have been equivocal. Thus, the purpose of the present study is to determine factors predictive of rehospitalization and functional decline in HF patients receiving home health care and identify whether specific approaches to delivery of care (higher visit intensity) is associated with lower rehospitalization and functional status decline, potentially reducing the burden of HF on individual patients and the health care system. The Andersen Behavioral Model provides the conceptual framework. The study employs a large data base design linking home health care clinical data (OASIS) with claims data (home health and hospital), county level (numbers of nursing homes, home health care agencies, and hospitals and location for determining urban-rural nature) and agency level (profit status and hospital affiliation) data for patients with Medicare. Hospital data will include 6 months prior to and 6 months following the initiation home health care services, providing a more comprehensive view of hospital use. The linked data set will allow us to determine the patient factors associated with rehospitalization and functional status decline and examine whether higher visit intensity is associated with less rehospitalization, fewer rehospitalization days, longer time to rehospitalization and less functional status decline. Based on 2003 figures, we anticipate 100,000 eligible subjects with HF, 11.000 of whom will be rehospitalized and 20,000 of whom will have a functional status decline. Analysis will use a multi-level modeling approach because of the nested nature of the data. This study is innovative in that it uses national data for all HF patients receiving Medicare home health care and uses county level and agency level data in addition to patient level data which has not been done before in this population. Sub-sample analysis will include the oldest old (>85 years) and minority ethnicity. The clinical application of information from this study, then, is directly relevant to home health care practitioners in designing care practices (how many visits) and for physicians and hospitals who order home health care for HF patients.

描述（由申请人提供）：心力衰竭（HF）是美国人的高负担状况，为他们服务的医疗保健系统是65岁以上患者住院的主要原因，在指数住院住院后6个月内，重新住院率高达65％。心力衰竭的患者功能状况也逐渐下降。家庭急性后跟进是减轻美国医疗保健系统心力衰竭负担的一种策略。家庭卫生保健机构是心力衰竭患者最常见的急性后护理提供者。然而，几乎没有证据表明最有效的方法可以减少重新住院并改善接受家庭医疗保健的HF患者的功能状况。在家庭医疗保健中，几乎没有研究访问和结果之间的关系，结果是模棱两可的。因此，本研究的目的是确定接受家庭医疗保健的HF患者的重新住院和功能下降的因素，并确定特定的护理交付方法（较高的访问强度）是否与较低的重新住院和功能状况下降有关，可能会减轻个人患者和医疗保健系统的HF负担。安徒生的行为模型提供了概念框架。该研究采用了大型数据库设计，将家庭保健临床数据（OASIS）与索赔数据（家庭健康和医院），县级（疗养院的数量，家庭医疗保健机构的数量，医院的数量以及确定城市农村自然）和代理机构水平（利润状况和医院隶属关系）数据联系起来。医院的数据将包括在启动家庭保健服务之前的6个月和6个月内，提供了对医院使用的更全面的看法。链接的数据集将使我们能够确定与重新住院和功能状态下降相关的患者因素，并检查较高的访问强度是否与较少的重新住院，更少的重新住院日，更长的重新住院时间和功能状态下降相关。根据2003年的数字，我们预计有100,000名HF的合格受试者，其中11.000将被重新住院，其中20,000名将使功能状况下降。由于数据的嵌套性质，分析将使用多层建模方法。这项研究具有创新性，因为它对所有接受Medicare家庭医疗保健的HF患者都使用了国家数据，除了患者级别的数据外，还使用县级和代理水平数据，而患者级别的数据尚未在此人群中进行。子样本分析将包括最古老的旧（> 85年）和少数族裔。因此，这项研究的信息的临床应用与家庭医疗保健从业人员设计护理实践（访问多少）以及为HF患者订购家庭医疗保健的医师和医院直接相关。