Role of Long-Term Acute Care Hospitals

长期急症护理医院的作用

基本信息

批准号：
9161996
负责人：
Anil Naga Makam
金额：
$ 12.15万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-15 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9161996
关键词：
Accounting Acute Admission activity Adopted Aging Antibiotics Area Award Caring Clinical Cognitive Complement Complex Data Data Set Effectiveness Elderly Electronic Health Record Ensure Explosion Faculty Funding Geriatrics Goals Growth Health Health Services Health Services Research Home environment Hospitalists Hospitalization Hospitals Individual Intensive Care Units Intravenous Lead Length of Stay Marketing Measures Mechanical ventilation Medical Medicare Medicare claim Mentors Methods Modeling Outcome Outcomes Research Patient-Focused Outcomes Patients Policies Provider Recovery Rehabilitation Outcome Rehabilitation therapy Reporting Research Research Personnel Research Training Resources Role Series Services Severities Severity of illness Site Skilled Nursing Facilities Source Statistical Methods Training United States Agency for Healthcare Research and Quality Variant Work beneficiary care episode career comparative effectiveness compare effectiveness cost design effectiveness research evidence base experience functional outcomes geographic difference health care service utilization high risk hospital patient care hospital utilization improved outcome meetings mortality multidisciplinary multilevel analysis payment policy implication rehabilitative care training opportunity wound

Accounting Acute Admission activity Adopted Aging Antibiotics Area Award Caring Clinical Cognitive Complement Complex Data Data Set Effectiveness Elderly Electronic Health Record Ensure Explosion Faculty Funding Geriatrics Goals Growth Health Health Services Health Services Research Home environment Hospitalists Hospitalization Hospitals Individual Intensive Care Units Intravenous Lead Length of Stay Marketing Measures Mechanical ventilation Medical Medicare Medicare claim Mentors Methods Modeling Outcome Outcomes Research Patient-Focused Outcomes Patients Policies Provider Recovery Rehabilitation Outcome Rehabilitation therapy Reporting Research Research Personnel Research Training Resources Role Series Services Severities Severity of illness Site Skilled Nursing Facilities Source Statistical Methods Training United States Agency for Healthcare Research and Quality Variant Work beneficiary care episode career comparative effectiveness compare effectiveness cost design effectiveness research evidence base experience functional outcomes geographic difference health care service utilization high risk hospital patient care hospital utilization improved outcome meetings mortality multidisciplinary multilevel analysis payment policy implication rehabilitative care training opportunity wound

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项目摘要

PROJECT SUMMARY/ABSTRACT This GEMSSTAR R03 award will establish Dr. Anil Makam as a clinician-investigator focused on the impact of post-acute care on health outcomes after acute illness in the elderly. This R03 award will provide him the support needed to develop expertise in 3 focused areas: (1) geriatric clinical training in post-acute care; (2) health services research (HSR) using Medicare data; and (3) advanced statistical methods in comparative effectiveness research (CER). To achieve these goals, Dr. Makam has assembled an expert multidisciplinary team in HSR, CER, geriatrics, rehabilitation, and post-acute care. His primary mentor, Dr. Ethan Halm, has extensive experience in HSR, CER and mentoring junior faculty to become independent investigators. His scientific advisors include Dr. Jim Goodwin, a leading expert in using Medicare data for aging research, and Dr. Song Zhang, an expert in advanced biostatics. Dr. Makam will also benefit from the expertise of 2 renowned clinical advisors in geriatrics (Rubin) and post-acute care (Muldoon). The use of post-acute care among the elderly is rising, and accounts for 73% of the geographic variation in Medicare spending. Long-term acute care hospitals (LTACs) are the fastest growing segment of post-acute care. Despite this growth and variation, little is known about why hospitalized older adults are discharged to LTACs versus receiving continued care in the acute care hospital (ACH), and which setting will optimize their recovery. Informed by his clinical experience as a hospitalist and his preliminary data, Dr. Makam will conduct a series of national studies to answer these essential questions. He will use national Medicare data to identify patient, hospital, and regional-level factors associated with LTAC use (vs. ACH) and quantify the degree of variation at each level (Aim 1). To comparatively assess the effectiveness of LTACs versus continued care in an ACH on outcomes, utilization, costs, and spending, Dr. Makam will use propensity score and instrumental variable analyses to control for both measured and unmeasured differences in the selection of which older adults are discharged to a LTAC (Aim 2). This research plan leverages existing institutional resources, including the UTSW CTSA and Dr. Halm’s AHRQ-funded Center for Patient-Centered Outcomes Research, as well as Dr. Goodwin’s NIA-funded geriatric and rehabilitation outcomes research group. Finally, this training and research will complement his K23 proposal comparing LTACs versus skilled nursing facilities, the principal post-acute care alternate. Together, his R03 and K23 proposals will inform a subsequent R01 application to further study the comparative effectiveness of LTACs vs. alternate care options and their associated long-term functional and cognitive outcomes. This proposal and the subsequent research will directly inform practice and policy by building the evidence base to assist patients, providers, and payers to ‘choose wisely’ in post-acute care.

项目摘要/摘要该GEMSSTAR R03奖将建立Anil Makam博士作为临床评估者，重点是影响。急性急性治疗急性疾病后的健康状况。这个R03奖将为他提供在三个重点领域发展专业知识所需的支持：（1）急性后护理的老年临床培训；（2）卫生服务研究（HSR）使用Medicare数据；（3）比较的高级统计方法有效性研究（CER）。为了实现这些目标，Makam博士召集了一个专家的多学科霍斯，CER，老年医学，康复和急性护理的团队。他的主要导师Ethan Halm博士有在HSR，CER和心理初级教职员工中获得独立研究人员的丰富经验。他的科学顾问包括使用Medicare数据进行衰老研究的主要专家Jim Goodwin博士，高级生物统计学专家Song Zhang博士。马卡姆博士还将受益于2的专业知识老年医学（鲁宾）和急性护理（Muldoon）的著名临床顾问。古老的急性后护理的使用正在上升，占地理差异的73％医疗保险支出。长期急诊医院（LTACS）是急性后增长最快的部分关心。尽管增长和差异，但对于为什么住院的老年人出院的原因鲜为人知 LTACS与在急诊医院（ACH）中接受持续护理，哪种设置将优化其恢复。根据他作为住院医生的临床经验和他的初步数据的了解，Makam博士将进行一系列的国家研究来回答这些基本问题。他将使用国家医疗保险数据来识别患者，医院和与使用LTAC使用相关的区域级别因素（与ACH）并量化每个级别的变化（AIM 1）。相对评估LTAC与持续护理的有效性 Makam博士对结果，利用，成本和支出的ACH进行可变分析以控制测量和未测量的差异的选择成年人被排放到LTAC（AIM 2）。该研究计划利用现有的机构资源，包括UTSW CTSA和HALM博士的AHRQ资助的以患者为中心的结果研究中心以及古德温（Goodwin）博士的NIA资助的老年和康复结果研究小组。最后，这个训练研究将补充他的K23提案，以比较LTAC与熟练护士设施，校长急性护理替代方案。他的R03和K23提案一起将告知随后的R01申请进一步研究LTACS与替代护理选择及其相关的长期的比较有效性功能和认知结果。该提案和随后的研究将直接为实践和通过建立证据基础来协助患者，提供者和付款人来“明智地选择”急性后的政策关心。