Caregiving after discharge from the hospital

出院后的护理

基本信息

批准号：
10020306
负责人：
Rachel M Werner
金额：
$ 48.45万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-30 至 2023-05-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY Caregiving burden is a large and growing concern in the United States. The burden of caregiving is even greater when the care recipient has Alzheimer's disease or related dementias (ADRD). Older adults are often in particular need of assistance after hospitalization, during the post-acute period. This care has frequently been provided in inpatient post-acute care settings, such as skilled nursing facilities (SNFs). Close to 20% of hospital discharges go to a SNF and Medicare spent over $600 billion on post-acute care in 2015. Among persons with dementia, the percentage of people discharged to SNFs for post-acute care is more than double (48%), compared to the overall rate. Despite the large spending on SNFs, the value of inpatient post-acute care to patients is uncertain. As a result, reducing its use has been a common target for payers such as Medicare, particularly under alternative payment models that tie financial incentives to improving value and reducing the costs of health care. Alternative payment models, such as bundled payment initiatives, have thus resulted in a declining use of SNFs in the post-acute period. The shift toward discharging more patients directly home after hospitalization may come at the expense of caregivers and families, however, particularly for families of persons with dementia. This raises substantial concern about associated consequences, including the increased amount of needed caregiving (both the frequency and intensity of caregiving) and potential loss of work productivity due to these increased caregiving demands. Evaluating the impact of this shift on caregiving is essential to gain a more complete understanding of the full costs of the increase in home-based post-acute care. Our overall objective is to examine changes in caregiving in the post-acute period, particularly among persons with dementia, as the use of inpatient post-acute care declines in the context of payment reform. We will do so by combining several datasets (surveys and Medicare claims from 2011-2019) that contain detailed information on caregiving during the post-acute period. Our specific aims are to describe trends in the frequency, intensity, and total amount of caregiving in the post-acute period and the characteristics of care recipients and their caregivers; to estimate changes in the frequency, intensity, and total amount of caregiving during the post-acute period associated with implementation of bundled payment initiatives; and to explore changes in work productivity among those who care for a family member (captured via use of family medical leave) associated with bundled payment implementation. The results from this study will provide empirical evidence regarding how the declining use of SNF has impacted caregiving in the post- acute period.

项目概要在美国，看护负担是一个日益严重的问题。照顾的负担是均匀的当护理接受者患有阿尔茨海默病或相关痴呆症 (ADRD) 时，该风险更大。老年人常常特别是住院后的急性后期需要帮助。这种护理经常在住院急症后护理机构中提供，例如熟练护理机构 (SNF)。接近20% 2015 年，出院患者转入 SNF，医疗保险在急性期后护理方面的支出超过 6000 亿美元。患有痴呆症的人中，出院到 SNF 进行急性后期护理的人数比例是其两倍多 (48%)，与总体比率相比。尽管在 SNF 上花费了大量资金，但急性后住院患者的价值对病人的护理是不确定的。因此，减少其使用已成为付款人的共同目标，例如医疗保险，特别是在将财务激励与提高价值和价值联系起来的替代支付模式下降低医疗保健成本。因此，捆绑支付等替代支付模式已经导致急性期后 SNF 使用量下降。转向直接让更多患者出院然而，住院后回家可能会牺牲护理人员和家人的利益，特别是对于痴呆症患者的家人。这引起了人们对相关后果的严重担忧，包括所需护理量的增加（护理的频率和强度）和潜在的损失由于护理需求的增加，工作效率下降。评估这一转变的影响护理对于更全面地了解家庭护理增加的全部成本至关重要急性后护理。我们的总体目标是检查急性期后护理的变化，特别是在痴呆症患者中，由于付费情况下住院急性期后护理的使用率下降改革。我们将通过组合多个数据集（2011-2019 年的调查和医疗保险索赔）来做到这一点包含有关急性期后护理的详细信息。我们的具体目标是描述急性后期护理频率、强度和总量的趋势以及照顾者及其照顾者的特征；估计频率、强度和总量的变化实施捆绑支付后急性期的护理量倡议；并探索那些照顾家庭成员的人工作效率的变化（捕获通过使用家庭病假）与捆绑付款实施相关。这项研究的结果将提供有关 SNF 使用量减少如何影响术后护理的经验证据急性期。