Health Care Use After Functional Disability: Opportunities to Improve the Care of Older Adults

功能性残疾后的医疗保健使用：改善老年人护理的机会

基本信息

批准号：
10045778
负责人：
Claire Kathryn Ankuda
金额：
$ 24.28万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-10 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10045778
关键词：
Accident and Emergency department Activities of Daily Living Acute Address Aging Award Bathing Caregivers Caring Cessation of life Characteristics Clinical Cohort Studies Communities Complex Cost Sharing Data Data Sources Dementia Development Development Plans Disabled Persons Disease Economic Factors Economic Policy Elderly Enrollment Event Family Fibrinogen Geography Goals Health Health Policy Health Services Health Status Health and Retirement Study Health care facility Health system Healthcare Heterogeneity Hip Fractures Home Health Agency Home environment Hospitalization Individual Institution K-Series Research Career Programs Lead Leadership Length of Stay Link Medical Medicare Medicare claim Mentors Mentorship Methodology Methods Minority Groups Modeling Monitor Morbidity - disease rate Nursing Homes Older Population Outcome Outcome Study Palliative Medicine Patients Pattern Patterns of Care Physicians Policies Population Poverty Primary Care Physician Provider Quality of Care Reporting Research Research Personnel Resources Role Sentinel Shapes Skilled Nursing Facilities Surveys System Training Translating Variant Walking base beneficiary career caregiving community setting cost disability experience flexibility functional disability functional status health economics high risk hospital bed hospital readmission improved innovation insight mortality multiple chronic conditions programs racial minority skills social socioeconomics trend

项目摘要

PROJECT SUMMARY/ABSTRACT Functional disability profoundly impacts the health and health care use of older adults, and yet functional status is not consistently monitored by health systems, nor routinely collected by Medicare. Patients and their families frequently struggle with inadequate support for these unrecognized needs. While specific diseases or multimorbidity have traditionally been the focus of research investigating high and potentially burdensome health care use, disability, defined as needing help performing activities of daily living (ADLs), may be a more critical and universal factor. The relationship between disability and health care use is complex: medical conditions may result in both disability and health care use, disability and unmet care needs can lead to health care use, and hospitalization itself can cause disability. Variation in health system features and practice patterns, such as the numbers of hospital beds and local levels of health care intensity, impact care patterns at a regional level and may influence the relationship between disability and health care use. Nationally, the Medicare Advantage (MA) program is rapidly expanding and offers increasing flexibility in supplemental benefits that could better support older adults with disability. However, older adults with functional disability are more likely leave MA plans and may receive care from lower quality skilled nursing facilities and home health agencies in MA. It is unknown if MA plans are shifting care from facilities to the community and to unpaid caregivers in order to reduce costs. The Paul Beeson Emerging Leaders Career Development Award in Aging will support my effort to address this gap through research that will examine the relationship between disability and health care use at three levels: the individual, health system, and health policy. In SA1, I will investigate the individual-level heterogeneity of health care use after the first report of ADL disability using the Medicare claims-linked National Health and Aging Trends Study (NHATS), which allows for identification of the month of disability onset. In SA2, I will use the Health and Retirement Study and data capturing regional characteristics to assess the influence of regional health system features on health care use after disability. In SA3, I will use NHATS linked to Medicare data to examine differences in care setting (i.e., community vs. institutional care) and caregiving (i.e., paid and unpaid caregiving) between older adults with functional disability in MA vs. traditional Medicare. These scientific aims link closely with a comprehensive development plan through which I will gain advanced methodological expertise in trajectory analysis and hierarchical modeling, clinical and systems understanding in geriatric disability, health economics and policy insight, and the leadership skills to translate my findings to policy change. This five-year project leverages my extensive experience conducting survey-based research, the resources of my institution, and the expertise of my mentors to identify opportunities to improve the care of older adults while catalyzing my development as an independent researcher working to improve Medicare policy for older adults with functional disability.

项目摘要/摘要功能障碍深刻影响老年人的健康和医疗保健使用，但功能状态不是由卫生系统始终如一地监控，也不是由Medicare经常收集的。病人及其家人经常为这些未认识到的需求提供不足的支持而苦苦挣扎。而特定疾病或传统上，多个多发病一直是研究繁重且潜在繁重的研究的重点医疗保健使用，残疾，定义为需要进行日常生活的帮助，可能会更多关键和普遍因素。残疾与医疗保健使用之间的关系很复杂：医疗病情可能导致残疾和医疗保健使用，残疾和未满足的护理需求会导致健康护理使用，住院本身会导致残疾。卫生系统特征和实践的变化模式，例如医院病床的数量和当地医疗保健强度，影响护理模式区域层面，可能会影响残疾与医疗保健使用之间的关系。在全国范围内， Medicare Advantage（MA）计划正在迅速扩展，并提供了越来越多的补充灵活性可以更好地支持残疾老年人的好处。但是，功能障碍的老年人是更有可能离开MA计划，并可能从较低质量的熟练护理设施和家庭健康中获得护理马萨诸塞州的机构。尚不清楚MA计划是否将护理从设施转移到社区并无薪护理人员为了降低成本。保罗·比森（Paul Beeson）新兴领导者职业发展奖将支持我通过研究来解决这一差距的努力，该研究将研究残疾之间的关系以及三个级别的医疗保健使用：个人，卫生系统和卫生政策。在SA1中，我将调查使用Medicare的第一个ADL残疾报告后，医疗保健使用的个人水平异质性与索赔联系的国家卫生和老龄化趋势研究（NHATS），可以识别残疾发作。在SA2中，我将使用健康和退休研究以及捕获区域特征的数据评估区域卫生系统特征对残疾后医疗保健的影响。在SA3中，我会使用与Medicare数据相关的NHAT，以检查护理环境中的差异（即社区与机构护理）与MA与功能障碍的老年人之间的护理（即付费和无薪护理）在MA vs中传统的医疗保险。这些科学目标与我通过的全面发展计划紧密相关将获得轨迹分析和层次建模，临床和临床和分层建模方面的先进方法论专业知识系统理解老年残疾，健康经济学和政策洞察力以及领导技能将我的发现转化为政策变更。这个五年的项目利用了我的丰富经验基于调查的研究，我的机构的资源以及导师的专业知识来确定在催化我作为独立的发展的同时，有机会改善老年人的护理研究人员致力于改善功能残疾老年人的医疗保险政策。