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 #
5P01AG027296-10
Application #
9418567
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
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
Keohane, Laura M; Rahman, Momotazur; Thomas, Kali S et al. (2018) Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans. J Am Geriatr Soc 66:992-997
Shield, Renée; Winblad, Ulrika; McHugh, John et al. (2018) Choosing the Best and Scrambling for the Rest: Hospital-Nursing Home Relationships and Admissions to Post-Acute Care. J Appl Gerontol :733464817752084
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

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