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 #
2P01AG027296-06A1
Application #
8618222
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
$171,882
Indirect Cost
$63,093
Name
Brown University
Department
Type
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
02912
Kumar, Amit; Rahman, Momotazur; Trivedi, Amal N et al. (2018) Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: A secondary analysis of administrative data. PLoS Med 15:e1002592
Berry, Sarah D; Zullo, Andrew R; Lee, Yoojin et al. (2018) Fracture Risk Assessment in Long-term Care (FRAiL): Development and Validation of a Prediction Model. J Gerontol A Biol Sci Med Sci 73:763-769
Thomas, Kali S; Silver, Benjamin; Gozalo, Pedro L et al. (2018) Constructing a Measure of Private-pay Nursing Home Days. Med Care 56:e26-e31
Rivera-Hernandez, Maricruz; Kumar, Amit; Epstein-Lubow, Gary et al. (2018) Disparities in Nursing Home Use and Quality Among African American, Hispanic, and White Medicare Residents With Alzheimer's Disease and Related Dementias. J Aging Health :898264318767778
Kosar, Cyrus M; Thomas, Kali S; Gozalo, Pedro L et al. (2018) Effect of Obesity on Postacute Outcomes of Skilled Nursing Facility Residents with Hip Fracture. J Am Geriatr Soc 66:1108-1114
McCreedy, Ellen M; Weinstein, Barbara E; Chodosh, Joshua et al. (2018) Hearing Loss: Why Does It Matter for Nursing Homes? J Am Med Dir Assoc 19:323-327
Meyers, David J; Mor, Vincent; Rahman, Momotazur (2018) Medicare Advantage Enrollees More Likely To Enter Lower-Quality Nursing Homes Compared To Fee-For-Service Enrollees. Health Aff (Millwood) 37:78-85
Teno, Joan M; Gozalo, Pedro; Trivedi, Amal N et al. (2018) Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015. JAMA 320:264-271
Durfey, Shayla N M; Kind, Amy J H; Gutman, Roee et al. (2018) Impact Of Risk Adjustment For Socioeconomic Status On Medicare Advantage Plan Quality Rankings. Health Aff (Millwood) 37:1065-1072
Baier, Rosa R; Mitchell, Susan L; Jutkowitz, Eric et al. (2018) Identifying and Supporting Nonpharmacological Dementia Interventions Ready for Pragmatic Trials: Results From an Expert Workshop. J Am Med Dir Assoc 19:560-562

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