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）：垂死的疗养院（NH）居民在生命的最后30天内经常住院，导致健康状况较差和医疗保险费用较高。 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溢出效果）。 NH市场中临终关怀提供者的迅速增长以及这种增长的实质地理变化为我们提供了研究NH Hospice合作属性不断变化的关系与寿命终止（EOL）住院之间的关系的机会。长期目标是了解可用于改善垂死居民姑息治疗并降低成本的方法。这项研究的目的是了解NH杂种合作的特定属性与NH中的EOL住院治疗如何相关。理由是，这项研究将为对NH Hospice合作与EOL住院之间因果关系的进一步研究铺平道路，并最终为所有垂死的NH居民提供更好的临终关怀姑息治疗提供指导。使用2000年至2009年的国家数据，这项研究有两个目标。 AIM-1是通过检验所有NH死者中的以下2个假设来检查NH培训合作属性与EOL住院的属性之间的关系。 （1）如果居住在NH中，居民在死亡前30天内不太可能住院，并占用临终关怀量更高的情况，这是NH Hospice合作的排他性水平； （2）如果居住在NH中，居民可能会在30天内住院 临终关怀提供者，考虑了临终关怀的使用量。 AIM-2是探索AIM-1中确定的关系是否在临终关怀提供者增长率不同的州之间是否有所不同。这项研究具有创新性，因为它是第一个研究NH培训合作和EOL住院的排他性之间关系的研究，并且通过检查所有NH垂死的居民的临终关怀效果，而不仅仅是临终关怀的参与者，从而扩展了现有的研究。它还利用了纵向数据和临终关怀提供者增长率的地理变化，以最大程度地减少NH杂种合作与EOL住院之间的估计关系的潜在偏见。这项研究很重要，因为它将增加我们对NH杂种合作如何改善所有垂死的NH居民的护理，特别是EOL住院。这些发现对于政策制定者评估临终关怀使用的成本和收益都将很重要，以及对于NH提供者，就与临终关怀合作做出明智的决定。最终，减少EOL住院不仅会改善垂死居民的生活质量，而且还可以节省Medicare费用。