Corazzini Kirsten
Duke University School of Nursing, Durham, NC 27710, USA.
Health Serv Res. 2003 Oct;38(5):1263-81. doi: 10.1111/1475-6773.00176.
To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment.
DATA SOURCES/STUDY SETTING: Primary data collected on 355 case managers and 26 agency directors employed in June 1999 by 26 of the 27 regional agencies administering the Massachusetts Home Care Program for low-income elders.
Data were collected in a cross-sectional survey study design. A case manager survey included measures of work environment, demographics, and factorial survey vignette clients (N = 2,054), for which case managers assessed service eligibility levels. An agency director survey included measures of management practices.
DATA COLLECTION/EXTRACTION METHODS: Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and care plan levels while controlling for case-mix differences in agencies' clients.
Case managers did not supplement extant Medicare home health services, but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. This finding persisted when controlling for case mix and did not vary by work environment. Work environment affected overall care plan levels.
Study findings indicate systematic patterns of frontline resource allocation shaping the relationships among community-based long-term care payment sources. Further, results illustrate how nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics.
研究在一个由州政府资助的家庭护理项目中，个案管理员如何根据客户的医疗保险家庭健康护理状况信息来分配家庭护理服务，尤其关注工作环境的影响。
数据来源/研究背景：1999年6月，对管理马萨诸塞州低收入老年人家庭护理项目的27个区域机构中的26个机构所雇佣的355名个案管理员和26名机构主管收集的原始数据。
数据收集采用横断面调查研究设计。个案管理员调查问卷包括工作环境、人口统计学以及因子调查小插图客户（N = 2054）的测量指标，个案管理员据此评估服务资格水平。机构主管调查问卷包括管理实践的测量指标。
数据收集/提取方法：分层线性模型在控制各机构客户病例组合差异的同时，估计工作环境对客户接受医疗保险家庭健康护理与护理计划水平之间关系的影响。
个案管理员并未补充现有的医疗保险家庭健康服务，但确实为最近终止了医疗保险家庭健康护理服务的客户分配了更为慷慨的服务计划。在控制病例组合后，这一发现依然存在，且不受工作环境的影响。工作环境影响了整体护理计划水平。
研究结果表明，一线资源分配存在系统模式，塑造了社区长期护理支付来源之间的关系。此外，结果还说明了高层倡议的不一致实施可能部分归因于工作环境特征。
