Impact of Length of Stay and Number of Home Nursing Visits on Hospitalization

住院时间和家庭护理次数对住院的影响

• 批准号: 7909500
• 负责人: Melissa O'Connor
• 金额: $ 4.14万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7909500
• 关键词: Absenteeism at work; Acute; Address; Admission activity; Adverse event; Area; Caring; Data; Data Set; Discipline of Nursing; Doctor of Philosophy; Elderly; Fellowship; Goals; Health; Healthcare; Heart failure; Home Health Agency; Home Nursing Care; Home environment; Hospitalization; Hospitals; Left; Length of Stay; Link; Medicare; Nurses; Nursing Research; Outcome Assessment; Patients; Play; Process; Quality of life; Research; Risk; Role; Science; Time; Training; Visiting Nurse; beneficiary; care episode; cost; improved; patient home care; pre-doctoral; prevent; public health relevance

DESCRIPTION (provided by applicant): Rehospitalization among Medicare-reimbursed, home healthcare recipients is currently 29% - an all time high. Nearly 20% of all Medicare beneficiaries discharged from hospitals are rehospitalized within 30 days and 34% are rehospitalized within 90 days. Hospitalization costs incurred by Medicare recipients exceeded 471 billion dollars in 2007. Reducing hospitalizations is a major national objective as hospitalization leads to increased costs for payers and leaves geriatric patients at great risk for adverse events during and after hospitalization. Little is known about the role length of stay (LOS) in home care and number of nursing visits plays in preventing rehospitalization. One or both of these factors could be a significant determinant of rehospitalization unaccounted for in past work and the missing link in avoiding an unnecessary hospitalization. Both are nurse-driven home care processes are therefore amenable to change. The goal of this pre-doctoral training plan is to determine the impact home care LOS and number of nursing visits has on rehospitalization among Medicare-reimbursed home health recipients. The applicant proposes a predictive, secondary analysis of three merged national data sets from 2006: the Outcomes Assessment Information Set; the Home Health Agency Standard Analytic File; and the Hospital Standard Analytic File. The specific aims of this study are to 1.) Examine the relationship between home care LOS on the occurrence of rehospitalization within 90 days after home care discharge among heart failure patients who were not hospitalized during the home care episode; 2.)Examine the relationship between the number of home care nursing visits on occurrence of rehospitalization within 90 days after home care discharge among heart failure patients who were not hospitalized during the home care episode; 3.) Examine the relationship between home care LOS on time to hospitalization within 90 days after home care discharge among heart failure patients who were not hospitalized during the home care episode; 4.) Examine the relationship between the number of home care nursing visits on time to hospitalization within 90 days after home care discharge among heart failure patients who were not hospitalized during the home care episode. Project Relevance: This proposal addresses two nurse driven home healthcare processes, an understudied area of nursing research with few PhD prepared scholars. Findings from this proposed study will inform nursing science in one aspect of reducing acute care hospitalization and addresses three NINR strategic goals: 1.) promoting health, 2.) improving quality of life, and 3.) improving the transition from one care setting to another. PUBLIC HEALTH RELEVANCE: This proposal addresses geriatric home care, an understudied area of nursing research with few PhD prepared scholars. Research conducted through this fellowship will include a secondary analysis of a national data set (The Outcomes Assessment and Information Set) and Medicare hospital and home health claims data to gain an understanding of the impact length of stay in home care and number of home nursing visits on re-hospitalization of geriatric home care recipients. These factors are amenable to change and could be a significant determinant of ACH unaccounted for in past work and the missing link between the identification of risk for rehospitalization upon admission to home care and avoiding an unnecessary hospitalization.

描述（申请人提供）：医疗保险补偿，家庭医疗保健接收者之间的重新住院，目前为29％ - 历史最高。从医院出院的所有医疗保险受益人中，将近20％在30天内重新住院，并在90天内重新住院。医疗保险接受者在2007年产生的住院费用超过4710亿美元。降低住院是一个主要的国家目标，因为住院导致付款人的成本增加，并且使老年患者在住院期间和住院期间有不良事件的风险很大。关于住宿（LOS）在家庭护理中的作用和护理访问的数量在防止重新住院方面的作用鲜为人知。这些因素中的一个或两个因素可能是过去工作中未经责备的重新搬迁化的重要决定因素，并且在避免不必要的住院治疗方面缺少联系。因此，两者都是护士驱动的家庭护理过程，可以更改。 该博士前培训计划的目的是确定家庭护理的影响和护理访问的数量对医疗保险重新贷款的家庭健康接受者之间的重新住院。申请人提出了对2006年的三个合并国家数据集的预测性，次要分析：结果评估信息集；家庭健康机构标准分析文件；和医院的标准分析文件。这项研究的具体目的是1。 2.）检查家庭护理护理访问的数量与在家庭护理发作期间未住院的心力衰竭患者的家庭护理出院后的90天内发生重新住院的关系之间的关系； 3.）检查家庭护理LOS在家庭护理发作期间未住院的心力衰竭患者的90天内的家庭护理与住院治疗之间的关系； 4.）检查在家庭护理发作期间未住院的心力衰竭患者的家庭护理出院后的90天内，及时访问家庭护理护理的数量与住院关系之间的关系。 项目相关性：该提案涉及两个护士驱动的家庭医疗保健过程，这是一个研究研究的研究领域，研究了博士学位很少的学者。这项拟议的研究的发现将在减少急性护理住院治疗的一个方面为护理科学提供信息，并解决了三个NINR战略目标：1。）促进健康，2。）提高生活质量，以及3.）改善从一种护理环境到另一个护理环境的过渡。 公共卫生相关性：该提案涉及老年家庭护理，这是一个研究的护理研究领域，没有博士学位的学者。通过该奖学金进行的研究将包括对国家数据集（结果评估和信息集）以及Medicare医院和家庭健康索赔数据的次要分析，以了解家庭护理中住院时间的影响和家庭护理访问的数量，以重新纳入老年家庭护理接受者。这些因素是可以改变的，并且可能是过去工作中无法说明的ACH的重要决定因素，以及在入院护理后重新住院风险的识别与避免不必要的住院治疗之间的缺失联系。