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.

项目概要/摘要功能障碍深刻影响老年人的健康和医疗保健使用，但功能状态卫生系统没有持续监测，医疗保险也没有定期收集。患者及其家属经常因对这些未被认识到的需求的支持不足而苦苦挣扎。虽然特定疾病或传统上，多重发病率一直是调查高且潜在负担的研究重点医疗保健使用、残疾（定义为需要帮助进行日常生活活动 (ADL)）可能是一个更重要的问题关键和普遍因素。残疾与医疗保健使用之间的关系很复杂：医疗情况可能会导致残疾和医疗保健的使用，残疾和未满足的护理需求可能会导致健康护理使用和住院本身可能会导致残疾。卫生系统特征和实践的差异模式，例如医院床位数量和当地医疗保健强度水平，影响着医疗保健模式区域层面，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) 计划正在迅速扩大，并在补充方面提供越来越大的灵活性可以更好地支持残疾老年人的福利。然而，患有功能障碍的老年人更有可能退出 MA 计划，并可能接受质量较低的熟练护理机构和家庭保健机构的护理马萨诸塞州的机构。目前尚不清楚 MA 计划是否会将护理从设施转移到社区并无偿提供照顾者，以降低成本。保罗·比森老龄化领域新兴领袖职业发展奖将支持我通过研究来解决这一差距的努力，该研究将考察残疾之间的关系以及三个层面上的医疗保健使用：个人、卫生系统和卫生政策。在SA1中，我会调查使用医疗保险首次报告 ADL 残疾后，个人层面的医疗保健使用存在异质性与索赔相关的国家健康和老龄化趋势研究 (NHATS)，该研究可以识别索赔月份残疾发作。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使用的影响。在SA3中，我将使用 NHATS 与医疗保险数据相关联，以检查护理环境的差异（即社区与机构护理）以及 MA 与功能障碍老年人之间的护理（即有偿和无偿护理）传统医疗保险。这些科学目标与全面发展计划密切相关，我通过该计划将获得轨迹分析和分层建模、临床和对老年残疾、卫生经济学和政策洞察力的系统理解，以及领导技能将我的发现转化为政策变化。这个为期五年的项目利用了我丰富的经验基于调查的研究、我所在机构的资源以及我导师的专业知识来确定改善老年人护理的机会，同时促进我作为独立人士的发展研究人员致力于改善功能障碍老年人的医疗保险政策。