Attributes of nursing home-hospice collaborations & end of life hospitalizations

疗养院与临终关怀合作的特点

• 批准号: 8582937
• 负责人: Shubing Cai
• 金额: $ 9.12万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8582937
• 关键词: Accounting; Address; Advocate; Aging; Caring; Cessation of life; Characteristics; Collaborations; Conflict (Psychology); Contracts; Costs and Benefits; Country; Data; Data Set; Exposure to; Goals; Growth; Health; High Prevalence; Hospice Care; Hospitalization; Individual; Knowledge; Lead; Life; Marketing; Medicare; Mission; National Institute on Aging; Nursing Homes; Outcome; Palliative Care; Pattern; Philosophy; Policies; Policy Maker; Provider; Public Health; Quality of life; Research; Testing; Variant; care delivery; cost; end of life; geographic difference; hospice environment; improved; innovation; public health relevance; rapid growth; trend

DESCRIPTION (provided by applicant): Dying nursing home (NH) residents are frequently hospitalized within the last 30 days of their lives, resulting in worse health outcomes and high Medicare costs. While it has been shown that hospice use leads to lower hospitalization rates among hospice enrollees, it is unclear how the attributes of NH-hospice collaborations - specifically the volume of hospice use and exclusivity of the collaboration (i.e. whether a NH primarily collaborates with one versus two or more providers) - are associated with hospitalizations among all NH dying residents (NH-hospice collaborations may also benefit non-hospice residents through spill-over effects). The rapid growth of hospice providers in NH markets and substantial geographic variations in such growth provide us with an opportunity to study the relationship between changing attributes of NH-hospice collaborations and end-of-life (EOL) hospitalizations. The long-term goal is to understand the approaches that can be used to improve palliative care for dying residents and to reduce costs. The objective of this study is to understand how specific attributes of NH-hospice collaborations are associated with EOL hospitalizations in NH. The rationale is that this study will pave the way for further in-depth studies of the causal relationship between NH-hospice collaborations and EOL hospitalizations, and ultimately provide guidance for better hospice palliative care delivery to all dying NH residents. Using national data from 2000-2009, this study has two aims. Aim-1 is to examine the relationship between attributes of NH-hospice collaborations and EOL hospitalizations by testing the following 2 hypotheses among ALL NH decedents. (1) A resident is less likely to be hospitalized in the 30 days before death if residing in a NH with a higher volume of hospice use, accounting for the level of exclusivity of NH-hospice collaborations; and (2) A resident is likely o be hospitalized in the 30 days before death if residing in a NH with an exclusive relationship with a hospice provider, accounting for the volume of hospice use. Aim-2 is to explore whether the relationship identified in Aim-1 varies across states with different growth rates of hospice providers. This study is innovative because it is the first study to examine the relationship between exclusivity of NH-hospice collaborations and EOL hospitalizations, and it extends existing research by examining the effect of hospice use among all NH dying residents rather than only hospice enrollees. It also takes advantage of both longitudinal data and the geographic variations in the growth rates of hospice providers to minimize the potential bias in the estimated relationship between NH-hospice collaborations and EOL hospitalizations. This study is significant because it will add to our understanding of how NH-hospice collaborations can improve care, specifically EOL hospitalizations, for all dying NH residents. The findings will be important both for policymakers to evaluate the costs and benefits of hospice use, and for NH providers to make informed decisions about collaborating with hospices. Ultimately, reducing EOL hospitalizations will not only improve the quality of life for dying residents, but alo save Medicare costs.

描述（由申请人提供）：临终疗养院 (NH) 居民经常在生命的最后 30 天内住院，导致健康状况恶化和医疗保险费用高昂。虽然已经表明临终关怀的使用可以降低临终关怀参与者的住院率，但尚不清楚 NH 与临终关怀合作的属性如何，特别是临终关怀使用的数量和合作的排他性（即 NH 是否主要与一个人合作，而不是与一个人合作）两个或更多提供者） - 与所有 NH 临终居民的住院治疗相关（NH 与临终关怀合作也可能通过溢出效应使非临终关怀居民受益）。 NH 市场临终关怀服务提供商的快速增长以及这种增长的巨大地理差异为我们提供了研究 NH 临终关怀合作属性变化与临终 (EOL) 住院治疗之间关系的机会。长期目标是了解可用于改善临终居民的姑息治疗并降低成本的方法。本研究的目的是了解新罕布什尔州临终关怀合作的具体属性如何与新罕布什尔州的 EOL 住院治疗相关。理由是，这项研究将为进一步深入研究 NH 临终关怀合作与 EOL 住院之间的因果关系铺平道路，并最终为向所有临终 NH 居民提供更好的临终关怀护理提供指导。本研究利用 2000 年至 2009 年的全国数据，有两个目的。 Aim-1 是通过在所有 NH 死者中检验以下 2 个假设来检查 NH 临终关怀合作属性与 EOL 住院治疗之间的关系。 (1) 如果居住在临终关怀机构使用量较高的 NH 的居民，其在死亡前 30 天内住院的可能性较小，这说明了 NH 与临终关怀机构合作的排他性水平； (2) 如果居住在与 NH 存在排他关系的居民，则可能会在死亡前 30 天内住院治疗 临终关怀服务提供者，占临终关怀服务的使用量。 Aim-2 旨在探讨 Aim-1 中确定的关系是否因临终关怀提供者增长率不同的州而异。这项研究具有创新性，因为它是第一项检验 NH 临终关怀合作排他性与 EOL 住院治疗之间关系的研究，并且通过检验临终关怀服务对所有 NH 临终居民（而不仅仅是临终关怀参与者）的影响，扩展了现有研究。它还利用纵向数据和临终关怀提供者增长率的地理差异，最大限度地减少 NH 临终关怀合作与 EOL 住院之间估计关系的潜在偏差。这项研究意义重大，因为它将加深我们对新罕布什尔州临终关怀中心合作如何改善所有临终新罕布什尔州居民的护理，特别是临终住院治疗的理解。研究结果对于政策制定者评估临终关怀机构使用的成本和收益以及NH 提供者就与临终关怀机构合作做出明智的决定都非常重要。最终，减少临终住院治疗不仅可以改善临终居民的生活质量，还可以节省医疗保险费用。