In response to changing policies and market conditions, hospitals must make decisions about how to staff the role of the attending physician since this individual plays a pivotal role in coordinating patient care, including timely and safe discharges that avoid hospital readmission. In 2013, hospitals are now penalized for higher than expected 30-day readmissions rates. In this application, we propose to study 3 paradigmatic illness trajectories among NH residents with severe functional impairment in order to understand how hospitals choose to staff the attending physician role: 1) dementia with advance cognitive;2) end organ dysfunction from CHF;and 3) hospitalized NH residents with pneumonia with pre-existing severe functional impairment. Dementia is a paradigmatic illness with prolonged severe functional impairment where medical treatment decisions must weigh quantity vs. quality of life. The latter two cohorts challenge health care providers to coordinate care across health care settings to avoid hospital readmissions and to make decisions with the patient and/or family regarding the goals of care. Using the MDS and Medicare claims data from 2000 to 2014, we propose to characterize hospitals'decisions to staff the role of the attending physician (Aim I) and examine the impact of those decisions on clinical outcome and health care utilization experienced by frail elderly, NH residents (Aim II). As of 2013, hospitals are faced with penalties for having a higher than expected 30 day re-hospitalization rates for patients with acute myocardial infarction, congestive heart failure, and pneumonia.
Our third aim i s to estimate the intended and potential unintended consequence of this new policy. A final fourth aim proposes to conduct 8 case studies to understand how hospitals with higher and lower rates of 30-day readmission organize physician services and coordinate care with the NH medical staff to provide high quality of care for each of these 3 proposed cohorts of frail, older persons. The proposed research will provide policy relevant information to examine observed dramatic changes in characteristics and hospital staffing the role of the attending physician as well as evaluate the impact of ACA penalties for hospitals with higher rates of 30 days hospital readmissions.

Public Health Relevance

Increasingly, the US Health Care system will need to provide medical care for an aging population, many now with chronic illness with progressive functional decline. The goal of this research is to study how American hospitals in response to changing policies and market conditions staff the role of the attending physician and how those choices affect clinical outcomes and health care utilization.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
2P01AG027296-06A1
Application #
8618224
Study Section
Special Emphasis Panel (ZAG1-ZIJ-3 (01))
Project Start
Project End
Budget Start
2014-02-15
Budget End
2015-01-31
Support Year
6
Fiscal Year
2014
Total Cost
$238,573
Indirect Cost
$89,754
Name
Brown University
Department
Type
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
02912
Rivera-Hernandez, Maricruz; Leyva, Bryan; Keohane, Laura M et al. (2016) Quality of Care for White and Hispanic Medicare Advantage Enrollees in the United States and Puerto Rico. JAMA Intern Med 176:787-94
Berridge, Clara; Tyler, Denise A; Miller, Susan C (2016) Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey. J Appl Gerontol :
Mor, Vincent; Rahman, Momotazur; McHugh, John (2016) Accountability of Hospitals for Medicare Beneficiaries' Postacute Care Discharge Disposition. JAMA Intern Med 176:119-21
Rahman, Momotazur; Grabowski, David C; Mor, Vincent et al. (2016) Is a Skilled Nursing Facility's Rehospitalization Rate a Valid Quality Measure? Health Serv Res 51:2158-2175
Schoenfeld, Andrew J; Zhang, Xuan; Grabowski, David C et al. (2016) Hospital-skilled nursing facility referral linkage reduces readmission rates among Medicare patients receiving major surgery. Surgery 159:1461-8
Teno, Joan M; Gozalo, Pedro; Khandelwal, Nita et al. (2016) Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds. JAMA Intern Med 176:1809-1816
Rahman, Momotazur; Norton, Edward C; Grabowski, David C (2016) Do hospital-owned skilled nursing facilities provide better post-acute care quality? J Health Econ 50:36-46
Baier, Rosa R; Trivedi, Amal N (2016) For Hospital Readmissions, Hindsight is Not 20/20. J Gen Intern Med 31:1270-1271
Rahman, Momotazur; McHugh, John; Gozalo, Pedro L et al. (2016) The Contribution of Skilled Nursing Facilities to Hospitals' Readmission Rate. Health Serv Res :
Jung, Hye-Young; Trivedi, Amal N; Grabowski, David C et al. (2016) Does More Therapy in Skilled Nursing Facilities Lead to Better Outcomes in Patients With Hip Fracture? Phys Ther 96:81-9

Showing the most recent 10 out of 118 publications