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 #
5P01AG027296-10
Application #
9418566
Study Section
Special Emphasis Panel (ZAG1)
Project Start
2007-09-15
Project End
Budget Start
2018-02-01
Budget End
2019-01-31
Support Year
10
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Brown University
Department
Type
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
Zhang, Tingting; Zullo, Andrew R; Shireman, Theresa I et al. (2018) Epidemiology of hip fracture in nursing home residents with multiple sclerosis. Disabil Health J 11:591-597
Rahman, Momotazur; Gadbois, Emily A; Tyler, Denise A et al. (2018) Hospital-Skilled Nursing Facility Collaboration: A Mixed-Methods Approach to Understanding the Effect of Linkage Strategies. Health Serv Res 53:4808-4828
McHugh, John P; Zinn, Jacqueline; Shield, Renee R et al. (2018) Strategy and risk sharing in hospital-postacute care integration. Health Care Manage Rev :
Trivedi, Amal N; Leyva, Bryan; Lee, Yoojin et al. (2018) Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans. N Engl J Med 378:262-269
Silver, Benjamin C; Rahman, Momotazur; Wright, Brad et al. (2018) Effects of Medicare Medical Reviews on Ambiguous Short-Stay Hospital Admissions. Health Serv Res 53:4747-4766
Li, Qijuan; Rahman, Momotazur; Gozalo, Pedro et al. (2018) Regional Variations: The Use Of Hospitals, Home Health, And Skilled Nursing In Traditional Medicare And Medicare Advantage. Health Aff (Millwood) 37:1274-1281
Tyler, Denise A; McHugh, John P; Shield, Renée R et al. (2018) Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay. Health Serv Res 53:4848-4862
Dore, David D; Zullo, Andrew R; Mor, Vincent et al. (2018) Age, Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents. J Am Med Dir Assoc 19:328-332.e2
Berridge, Clara; Tyler, Denise A; Miller, Susan C (2018) Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey. J Appl Gerontol 37:419-434
Thomas, Kali S; Ogarek, Jessica A; Teno, Joan M et al. (2018) Development and Validation of the Nursing Home Minimum Data Set 3.0 Mortality Risk Score (MRS3). J Gerontol A Biol Sci Med Sci :

Showing the most recent 10 out of 160 publications