Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
Health Serv Res. 2019 Jun;54(3):564-574. doi: 10.1111/1475-6773.13138. Epub 2019 Mar 20.
To measure the association between clinician specialization in nursing home (NH) practice and outcomes of patients who received postacute care in skilled nursing facilities (SNFs).
Medicare claims and NH assessments for 2 118 941 hospital discharges to 14 526 SNFs in January 2012-October 2014 and MD-PPAS data for 52 379 clinicians.
Generalist physicians and advanced practitioners with ≥ 90 percent of claims for NH-based care were considered NH specialists. The primary clinician during each SNF stay was determined based on plurality of claims during that stay. We estimated the effect of being treated by a NH specialist on 30-day rehospitalizations, successful discharge to community, and 60-day episode-of-care Medicare payments (Parts A and B). All models included patient demographics, clinical variables, and SNF fixed effects.
Nursing home specialists' patients were less likely to be rehospitalized (14.71 percent vs 16.23 percent; adjusted difference, -1.51 percent, 95% CI -1.78 to -1.24), more likely to be successfully discharged to community (56.33 percent vs 55.49 percent; adjusted difference, 0.84 percent, 95% CI 0.54 to 1.14), but had higher 60-day Medicare payments ($31 628 vs $31 292; adjusted difference, $335; 95% CI $242 to $429).
Clinicians who specialize in NH practice may achieve better postacute care outcomes at slightly higher costs.
衡量养老院（NH）执业的临床医生专业化与在熟练护理设施（SNF）接受康复护理的患者结局之间的关联。
2012 年 1 月至 2014 年 10 月期间，针对向 14526 家 SNF 转诊的 2118941 例住院患者的医疗保险索赔和 NH 评估数据，以及针对 52379 名临床医生的 MD-PPAS 数据。
将 NH 护理索赔占比≥90%的全科医生和高级执业医师视为 NH 专家。每位患者在 SNF 住院期间的主要临床医生，是根据该期间内索赔数量的多少来确定的。我们估计了由 NH 专家治疗对 30 天内再住院率、成功出院到社区以及 60 天内医疗保险支付（A 部分和 B 部分）的影响。所有模型均包含患者人口统计学、临床变量和 SNF 固定效应。
NH 专家的患者再住院率较低（14.71%比 16.23%；调整差异，-1.51%，95%CI -1.78 至-1.24），成功出院到社区的比例更高（56.33%比 55.49%；调整差异，0.84%，95%CI 0.54 至 1.14），但在 60 天内的医疗保险支付更高（31628 美元比 31292 美元；调整差异，335 美元，95%CI 242 美元至 429 美元）。
专门从事 NH 实践的临床医生可能会以略高的成本实现更好的康复护理结局。
