The Changing Landscape of Post-Acute Care and Health Outcomes for Older Adults

老年人急性后护理和健康结果的变化

• 批准号: 9895614
• 负责人: Michael Lawrence Barnett
• 金额: $ 18.34万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9895614
• 关键词: Address; Admission activity; Adult; Affect; Age; Age-Years; Aging; Area; Automobile Driving; Caring; Case Series; Case Study; Clinical; Communities; Comprehensive Health Care; Data; Development; Elderly; Faculty; Fracture; Future; Geriatrics; Goals; Health; Health Policy; Health Services Research; Health system; Heterogeneity; Hip Fractures; Home environment; Hospitalists; Hospitalization; Hospitals; Incentives; Inpatients; Interview; K-Series Research Career Programs; Literature; Measures; Medical; Medicare; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Modeling; Natural experiment; Outcome; Patients; Pattern; Physicians; Policies; Primary Care Physician; Privatization; Provider; Public Health Schools; Qualitative Methods; Qualitative Research; Quality of Care; Randomized; Replacement Arthroplasty; Research; Research Personnel; Review Literature; Safety; Sampling; Savings; Selection Bias; Site; Subgroup; Surveys; Techniques; Time; Training; Variant; Woman; Work; acute care; adverse outcome; base; bundled payment; care delivery; care fragmentation; care providers; career; comparative; design; experience; faculty mentor; falls; financial incentive; functional status; health care quality; health management; high risk; hospital readmission; improved; improved outcome; insight; instrument; large datasets; multidisciplinary; older patient; payment; professor; public health insurance; response; skills; statistics; wasting

PROJECT SUMMARY This career development award for Dr. Michael L. Barnett, a primary care physician at Brigham and Women’s Hospital and an assistant professor of health policy and management at the Harvard T.H. School of Public Health, will establish Dr. Barnett as a clinician investigator with expertise on improving the quality and value of care for older adults. This proposal builds on Dr. Barnett’s promising early career researching quality and fragmentation of care delivery and focuses on an increasingly important and understudied domain of fragmented care delivery for older adults: post-acute care (PAC). This K23 award will enable Dr. Barnett to pursue this research area and grow into an independent investigator through support for three training goals: 1) Acquiring skills in advanced quantitative methods for causal inference in large datasets, 2) Developing expertise in PAC for older patients, and 3) Acquiring skills in qualitative research and survey design. Dr. Barnett will pursue these training goals guided by a multidisciplinary faculty team led by primary mentor Dr. Arnold Epstein, an experienced junior faculty mentor with experience performing high-impact research in health care quality and health policy. Dr. Barnett’s co-mentors are Dr. David Grabowski, an expert in post- acute care policy and aging research and Dr. Ateev Mehrotra, who has expertise in episode-based payments and health services research. Dr. Barnett will also partner with distinguished scientific consultants to provide training and mentorship in statistics, geriatrics and qualitative methods. Use of PAC for older adults is growing rapidly, but little is known about whether PAC improves health outcomes for hospitalized older adults. New payment models, such as bundled payments, are increasingly driving providers to lower PAC use, but the potential health impact of this change is unknown. Dr. Barnett will examine the changing landscape of PAC with three integrated aims: first, Dr. Barnett will use Medicare administrative claims to examine the relationship between low rates of PAC use and health outcomes exploiting quasi-random assignment of patients to hospitalist physicians (Aim 1). Next, he will measure the impact on PAC use and health outcomes of a national bundled payment model for total lower joint replacement among high-risk vulnerable older adults who may be negatively impacted by lower PAC use (Aim 2). Finally, he will conduct a comparative series of case studies of hospitals with contrasting changes in PAC use after bundled payment implementation to identify practices associated with adapting to a new payment model (Aim 3). This research can directly inform current policy and payment reform for older adults to enhance the safe and effective use of PAC. Results from this work will form the basis of an R01 proposal to study the relationship between hospital-PAC integration and quality of care for hospitalized older adults.

项目概要 该职业发展奖授予迈克尔·L·巴尼特 (Michael L. Barnett) 博士，他是布里格姆医院的初级保健医生 哈佛大学 T.H. 妇女医院卫生政策与管理助理教授 公共卫生部门将任命 Barnett 博士为临床调查员，具有提高质量和 该提案建立在巴尼特博士早期职业研究质量的基础上。 和分散的护理服务，并重点关注一个日益重要且未被充分研究的领域 为老年人提供分散的护理服务：急性期后护理 (PAC) 该 K23 奖项将使 Barnett 博士能够 通过支持三个培训目标，追求这一研究领域并成长为一名独立研究者： 1) 获得在大型数据集中进行因果推理的高级定量方法的技能，2) 开发 老年患者 PAC 方面的专业知识，以及 3) 获得定性研究和调查设计的技能。 巴尼特将在主要导师 Dr. Barnett 博士领导的多学科教师团队的指导下追求这些培训目标。 阿诺德·爱泼斯坦 (Arnold Epstein)，一位经验丰富的初级教师导师，拥有在以下领域进行高影响力研究的经验 巴尼特博士的共同导师是后疾病专家大卫·格拉博夫斯基博士。 急性护理政策和老龄化研究以及 Ateev Mehrotra 博士，他在基于事件的支付方面拥有专业知识 巴尼特博士还将与杰出的科学顾问合作，提供 统计、老年病学和定性方法方面的培训和指导。 老年人使用 PAC 的情况正在迅速增长，但人们对 PAC 是否能改善健康知之甚少 住院老年人的结果越来越多，例如捆绑支付等新的支付模式。 促使医疗服务提供者减少 PAC 的使用，但这一变化对健康的潜在影响尚不清楚。 通过三个综合目标审视 PAC 不断变化的格局：首先，Barnett 博士将使用 Medicare 行政声称要检查低 PAC 使用率与健康结果之间的关系 利用将患者准随机分配给住院医师的方式（目标 1），他将衡量 全国全下关节置换捆绑支付模式对 PAC 使用和健康结果的影响 可能因 PAC 使用量减少而受到负面影响的高风险弱势老年人（目标 2）。 将针对 PAC 使用情况的对比变化对医院进行一系列案例研究 捆绑实施付款，以确定与适应新付款模式相关的做法（目标 3）这项研究可以直接为当前的老年人政策和支付改革提供信息，以增强老年人的安全感。 这项工作的结果将构成研究 PAC 的 R01 提案的基础。 医院-PAC 整合与住院老年人护理质量之间的关系。