Disparities in Nursing Home Access for Patients with ADRD

ADRD 患者进入疗养院的差异

• 批准号: 9516414
• 负责人: Shubing Cai
• 金额: $ 15.4万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9516414
• 关键词: Activities of Daily Living; Address; Aging; Algorithms; Area; Caring; Case Mixes; Catheters; Data; Data Set; Decubitus ulcer; Dimensions; Disincentive; Economics; Eligibility Determination; Epidemic; Equipment; Face; Goals; Health; Health Care Costs; Health Services Accessibility; Health Status; Home Nursing Care; Hospitalization; Impairment; Incentives; Incontinence; Individual; Intervention; Investments; Lead; Literature; Measures; Medicaid; Medicare; Medicare claim; Medicare/Medicaid; Modeling; Non obese; Nurse' s Role; Nursing Homes; Nursing Staff; Obesity; Outcome; Ownership; Pathway interactions; Patients; Policies; Population; Prevalence; Public Health; Quality of Care; Reporting; Research; Resources; Risk; Risk Factors; System; Testing; Time; base; cost; demographics; experience; falls; financial incentive; health care disparity; health disparity; innovation; payment; policy implication; pressure ulcer prevention; programs; prospective; trend

Project Summary. The escalating rates of obesity in nursing homes (NHs) present unique challenges to these facilities. Providing appropriate care to obese residents can be costly as obese residents have special care needs and accommodating these needs requires additional investment in equipment and staff time. However, the current case-mix payment systems do not recognize the additional costs associated with obesity (i.e. the case-mix algorithm is not rated on obesity status), and the resulting potential inverse financial incentives may create barriers for obese residents to receive high quality of care. It is important to understand the potential quality barriers faced by obese NH residents because suboptimal care, if existing, will not only impair obese residents' health conditions, but also incur unnecessary costs, such as potentially preventable hospitalizations, on the Medicare program. To date, there has been very limited empirical evidence bearing on this issue. Our prior study provided some preliminary findings that obese residents received lower quality of care than non- obese residents along one specific dimension - the prevention of pressure ulcers. However, the NH quality is multidimensional and quality measures are not necessarily to be correlated. There are no studies examining whether disparity exists in other NH quality outcomes for obese residents, and whether obese residents face barriers in accessing high quality NHs. Thus, the objective of this study is to understand disparities both in access to care and in quality of care experienced by obese residents. Based on an economic conceptual framework, the study has 2 specific aims: 1) Examine the disparity in quality of care, using multiple measures (fall, preventable hospitalizations etc.), received by obese and non-obese residents within the same facility, and whether such disparity varies with the facility ownership, state Medicaid reimbursement rate and market factors; 2) Understand the disparity in access to high quality NHs – that is, whether obese residents are less likely to be admitted to high quality NHs than non-obese residents – and the impact of quality report cards. This study is innovative because it is the first one to use a comprehensive set of quality measures to examine quality of care received by obese NH residents; it employs an economic framework to explore different pathways (i.e. care received within a NH and barriers to access to high quality facilities) that can lead to the overall difference in quality of care between obese and non-obese residents; and it explores how the quality gap varies with “external factors” such as state Medicaid policies and market factors, which will not only provide policy relevant implications, but also provide further evidence on the role of NH in the quality outcomes experienced by obese residents. This proposed research is significant because it addresses an emerging and growing public concern. Furthermore, it will provide information on the needs of care among obese residents and needs of policy interventions, with the goal of reducing health disparities, achieving better care and reducing health care costs.

项目摘要。疗养院 (NH) 中不断上升的肥胖率给这些群体带来了独特的挑战。 为肥胖居民提供适当的护理可能成本高昂，因为肥胖居民需要特殊护理。 需求并满足这些需求需要在设备和员工时间上进行额外投资。 目前的病例组合支付系统不承认与肥胖相关的额外费用（即 案例混合算法未根据肥胖状况进行评级），由此产生的潜在反向经济激励可能 了解潜在的障碍是为肥胖居民接受高质量护理创造的重要障碍。 肥胖的新罕布什尔州居民面临的质量问题，因为如果存在障碍，次优的护理不仅会损害肥胖患者的健康 居民的健康状况，但也会产生不必要的费用，例如可能可以预防的住院治疗， 迄今为止，关于这个问题的经验证据非常有限。 先前的研究提供了一些初步结果，即肥胖居民获得的护理质量低于非肥胖居民 肥胖居民在一个特定的方面——预防压疮然而，NH质量是。 多维和质量测量不一定是相关的 没有研究检验。 肥胖居民的其他 NH 质量结果是否存在差异，以及肥胖居民是否面临 因此，本研究的目的是了解两者之间的差异。 基于经济概念的肥胖居民获得护理的机会和护理质量。 根据框架，该研究有 2 个具体目标：1) 使用多种措施检查护理质量的差异 （跌倒、可预防的住院治疗等），由同一机构内的肥胖和非肥胖居民接收， 以及这种差异是否随设施所有权、州医疗补助报销率和市场而变化 2）了解获得高质量NHs的差异——即肥胖居民是否较少 与非肥胖居民相比，更有可能入住高质量的 NH 医院——以及质量报告卡的影响。 这项研究具有创新性，因为它是第一个使用一套全面的质量措施来检查 肥胖的新罕布什尔州居民接受的护理质量；它采用经济框架来探索不同的 途径（即在 NH 内接受的护理以及获得高质量设施的障碍） 肥胖居民和非肥胖居民之间护理质量的总体差异，并探讨了质量如何； 差距随着国家医疗补助政策和市场因素等“外部因素”的变化而变化，这不仅会影响 提供政策相关的影响，还提供关于 NH 在质量结果中的作用的进一步证据 这项拟议的研究意义重大，因为它解决了一个新兴的问题。 此外，它将提供有关肥胖居民护理需求的信息。 和政策干预的需求，以减少健康差距、实现更好的护理和 减少医疗保健费用。