The proposed project addresses the increasingly important issue of how hospitals and post-acute providers can collaborate to improve their patients' experience and reduce re-hospitalizations. There has been tremendous growth in post-acute care, particularly to Skilled Nursing Facilities (SNF), coinciding with increases in re-hospitalizations. Because Medicare policy has not levied penalties for re-admitting patients discharged to SNF, organizational strategies to ensure coordinated care across settings to prevent them are underdeveloped and hospitals' accountability for their patients' care upon discharge has been limited. Our proposal seeks to understand whether hospitals that preferentially discharge their PAC patients to a select number of SNFs mitigate the forces producing higher re-hospitalization since the hospitals and their preferred SNFs invest in coordinated transition protocols . There are provisions of the Affordable Care Act (ACA) designed to overcome reimbursement related barriers to collaboration between hospital and SNF. We propose to test their provisional effect on how hospitals and SNFs collaborate and the effect this has on re-hospitalization and related patient outcomes. Building upon a decade of national Medicare claims linked to SNF Minimum Data Set assessments and using a mixed quantitative and qualitative methodology, informed by transaction cost economics, we propose to: 1) develop and test a measure of hospital-SNF preferred provider relationship; 2) To estimate the effect of strong hospital-SNF relationships on the risk of 30-day re-hospitalization and nursing home residency, controlling for patient acuity, patient selection and market factors; 3) To empirically test the extent to which hospitals strengthen their partnerships (steer their discharged patients) to fewer SNFs in response to the introduction of ACA provisions and participation in ACO's and/or bundling initiatives overtime; and 4) to qualitatively examine the patterns of interaction and exchanges, at the administrative and clinical levels, between hospitals and SNFs to better understand markers of relationship strength as a qualitative test of our quantitative measure of hospital-SNF linkage.

Public Health Relevance

We study whether patients served by hospitals and nursing facilities with strong established collaborations will experience less re-hospitalization and whether the provisions of the Affordable Care Act, designed to make hospitals accountable for patients post-discharge, will increase partnerships with nursing facilities, thereby reducing re-hospitalizations.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
5P01AG027296-09
Application #
9232054
Study Section
Special Emphasis Panel (ZAG1-ZIJ-3)
Project Start
Project End
Budget Start
2017-02-01
Budget End
2018-01-31
Support Year
9
Fiscal Year
2017
Total Cost
$149,400
Indirect Cost
$45,604
Name
Brown University
Department
Type
Domestic Higher Education
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
02912
Keohane, Laura M; Trivedi, Amal N; Mor, Vincent (2017) Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries. Gerontologist 57:977-986
Thomas, Kali S; Baier, Rosa; Kosar, Cyrus et al. (2017) Individualized Music Program is Associated with Improved Outcomes for U.S. Nursing Home Residents with Dementia. Am J Geriatr Psychiatry 25:931-938
Keohane, Laura M; Grebla, Regina C; Rahman, Momotazur et al. (2017) First-dollar cost-sharing for skilled nursing facility care in medicare advantage plans. BMC Health Serv Res 17:611
Kosar, Cyrus M; Thomas, Kali S; Inouye, Sharon K et al. (2017) Delirium During Postacute Nursing Home Admission and Risk for Adverse Outcomes. J Am Geriatr Soc 65:1470-1475
Dore, David D; Zullo, Andrew R; Mor, Vincent et al. (2017) Age, Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents. J Am Med Dir Assoc :
Li, Qijuan; Keohane, Laura M; Thomas, Kali et al. (2017) Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees. JAMA Intern Med 177:1012-1018
Ankuda, Claire K; Mitchell, Susan L; Gozalo, Pedro et al. (2017) Association of Physician Specialty with Hospice Referral for Hospitalized Nursing Home Patients with Advanced Dementia. J Am Geriatr Soc 65:1784-1788
Berry, Sarah D; Zullo, Andrew R; Lee, Yoojin et al. (2017) Fracture Risk Assessment in Long-term Care (FRAiL): Development and Validation of a Prediction Model. J Gerontol A Biol Sci Med Sci :
Teno, Joan M; Gozalo, Pedro L; Trivedi, Amal N et al. (2017) Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014. JAMA Intern Med 177:1376-1378
Winblad, Ulrika; Mor, Vincent; McHugh, John P et al. (2017) ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals. Health Aff (Millwood) 36:67-73

Showing the most recent 10 out of 134 publications