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 #
5P01AG027296-09
Application #
9232055
Study Section
Special Emphasis Panel (ZAG1-ZIJ-3)
Project Start
2007-09-15
Project End
Budget Start
2017-02-01
Budget End
2018-01-31
Support Year
9
Fiscal Year
2017
Total Cost
$232,080
Indirect Cost
$78,515
Name
Brown University
Department
Type
Domestic Higher Education
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
02912
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 :
Durfey, Shayla N M; Kind, Amy J H; Buckingham, William R et al. (2018) Neighborhood disadvantage and chronic disease management. Health Serv Res :
Goldberg, Elizabeth M; Keohane, Laura M; Mor, Vincent et al. (2018) Preferred Provider Relationships Between Medicare Advantage Plans and Skilled Nursing Facilities Reduce Switching Out of Plans: An Observational Analysis. Inquiry 55:46958018797412
Rivera-Hernandez, Maricruz; Rahman, Momotazur; Mukamel, Dana B et al. (2018) Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Black and Hispanic Patients. J Gerontol A Biol Sci Med Sci :
Ogarek, Jessica A; McCreedy, Ellen M; Thomas, Kali S et al. (2018) Minimum Data Set Changes in Health, End-Stage Disease and Symptoms and Signs Scale: A Revised Measure to Predict Mortality in Nursing Home Residents. J Am Geriatr Soc 66:976-981
Keohane, Laura M; Trivedi, Amal N; Mor, Vincent (2018) The Role of Medicare's Inpatient Cost-Sharing in Medicaid Entry. Health Serv Res 53:711-729
Kosar, Cyrus M; Thomas, Kali S; Gozalo, Pedro L et al. (2018) Higher Level of Obesity Is Associated with Intensive Personal Care Assistance in the Nursing Home. J Am Med Dir Assoc 19:1015-1019

Showing the most recent 10 out of 160 publications