Post-acute Care Outcomes of Patients with Alzheimer's Disease and Related Dementias: the Role of Skilled Nursing Facility Specialists

阿尔茨海默病和相关痴呆症患者的急性后护理结果：熟练护理机构专家的作用

• 批准号: 10605213
• 负责人: Hye-Young Jung
• 金额: $ 63.28万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-15 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10605213
• 关键词: Administrator; Admission activity; Affect; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Caring; Characteristics; Clinical; Clinical assessments; Communication; Communities; Complex; Continuity of Patient Care; Data; Data Set; Databases; Emergency department visit; Employment; Fee-for-Service Plans; Goals; Grant; Growth; Health care facility; Hospitalization; Human Resources; Intervention; Interview; Length of Stay; Link; Long-Term Care; Marketing; Measures; Medicare; Medicare claim; Nurse Administrator; Nursing Homes; Nursing Staff; Outcome; Ownership; Patient Admission; Patient Care; Patient-Focused Outcomes; Patients; Penetration; Persons; Physician Executives; Physicians; Play; Policies; Prevalence; Process; Recovery; Research; Role; Sampling; Site; Skilled Nursing Facilities; Specialist; Structure; Training; Visit; Work; acute care; beneficiary; care coordination; care delivery; care outcomes; cost; evidence base; experience; functional improvement; functional outcomes; functional status; health care service utilization; hospital care; hospital readmission; hospitalization rates; improved; improved outcome; loss of function; memory care; readmission rates; residence; therapy development; trend

PROJECT SUMMARY Over 1.1 million patients admitted annually to skilled nursing facilities (SNFs) for post-acute care after a hospitalization have Alzheimer’s Disease or Related Dementias (ADRD), and their outcomes are poor and variable. Given the high clinical complexity and care coordination needs of patients with ADRD, one potential solution to improving the outcomes of patients with ADRD receiving SNF care is through physicians who specialize in SNF-based care. “SNFists” (i.e., physicians for whom SNF patients comprise the majority of their practice) are becoming increasingly common. Our prior work found a 37% increase in the prevalence of SNFists from 2012 to 2015, with a high degree of variability across markets. In this study, we will examine whether physicians specializing in SNF-based care improve functional outcomes and reduce potentially avoidable healthcare utilization (such as hospital readmissions) of patients with ADRD receiving post-acute care in SNFs. To accomplish these goals, we will expand an existing dataset of Medicare claims and SNF clinical assessment data for Medicare fee-for-service beneficiaries discharged from an acute care hospital to a SNF from 2012 through 2019. Using this database, we will examine the trends in physician specialization in SNF care in the context of market, facility, and physician characteristics. Next, we will measure the impact of physician specialization in SNF care on the outcomes and healthcare utilization of patients with ADRD using difference-in-differences cross-temporal matching. Lastly, we will conduct semi-structured interviews with key SNF personnel (e.g., director of nursing, medical director) to quantitatively identify practice strategies and care processes that differ between physicians in high- vs. low-performing SNFs based on the outcomes of patients with ADRD. When complete, these studies will inform practice and policy to optimize (increase or reduce) post- acute care patients’ access to physicians who specialize in SNF-based care. The findings will be used to develop interventions to improve the value of SNF-based post-acute care for patients with ADRD.

项目摘要 每年有超过110万患者向熟练的护士设施（SNF）接受急性后护理 住院患有阿尔茨海默氏病或​​相关痴呆症（ADRD），其结果很差，并且 多变的。鉴于ADRD患者的临床复杂性和护理协调需求很高，一个潜力 改善ADRD接受SNF护理患者结果的解决方案是通过医生 专门研究基于SNF的护理。 “ SNFIST”（即SNF患者的医生，大多数 练习）变得越来越普遍。我们先前的工作发现患病率增加了37％ 从2012年到2015年的snfists，市场各不相同。在这项研究中，我们将检查 专门从事基于SNF的护理的医生是否可以改善功能结果并减少潜在 可避免的医疗保健利用（例如医院再入院）ADRD接受急性后的患者 在SNF中关心。为了实现这些目标，我们将扩展现有的Medicare索赔数据集和SNF 从急诊医院出院的医疗保险费用受益人的临床评估数据 SNF从2012年到2019年。使用此数据库，我们将研究物理专业化的趋势 在市场，设施和物理特征的背景下，SNF护理。接下来，我们将衡量 使用ADRD患者的结果和医疗保健利用的物理专业 差异差异跨时空匹配。最后，我们将使用Key进行半结构化访谈 SNF人员（例如护士，医疗总监）定量确定实践策略和护理 高空医师的医师之间的过程不同。基于患者的结果，表现低下的SNF 与Adrd。完成后，这些研究将为实践和政策提供信息，以优化（增加或减少） - 急性护理患者与专门从事基于SNF的护理的医师的访问权限。调查结果将用于 开发干预措施，以提高基于SNF的ADRD患者的基于SNF的急性后护理。