Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Rural Health. 2020 Jan;36(1):94-103. doi: 10.1111/jrh.12365. Epub 2019 Apr 5.
Skilled nursing care (SNC) provides Medicare beneficiaries short-term rehabilitation from an acute event. The purpose of this study is to assess beneficiary, market, and hospital factors associated with beneficiaries receiving care near home.
The population includes Medicare beneficiaries who live in a rural area and received acute care from an urban facility in 2013. "Near home" was defined 3 different ways based on distances from the beneficiary's home to the nearest source of SNC. Results include unadjusted means and odds ratios from logistic regression.
About 69% of rural beneficiaries receiving acute care in an urban location returned near home for SNC. Beneficiaries returning home were white (odds ratio [OR] black: 0.69; other race: 0.79); male (OR: 1.07); older (OR age 85+ [vs 65-69]: 1.14); farther from SNC (OR: 1.01 per mile); closer to acute care (OR: 0.28, logged miles); and received acute care from hospitals that did not own a skilled nursing facility (owned OR: 0.77) and hospitals with: no swing bed (swing bed OR: 0.47), high case mix (OR: 3.04), and nonprofit status (for-profit OR: 0.85). Results varied somewhat across definitions of "near home."
Rural Medicare beneficiaries who received acute care far from home were more likely to receive SNC far from home. Because Medicare beneficiaries have the choice of where to receive SNC, policy makers may consider ensuring that new payment models do not incentivize provision of SNC away from home.
熟练护理（SNC）为医疗保险受益人提供急性疾病的短期康复。本研究的目的是评估与受益人、市场和医院相关的因素，这些因素与受益人在家附近接受护理有关。
研究对象包括居住在农村地区、2013 年在城市机构接受急性治疗的医疗保险受益人。“离家近”根据受益人家到最近 SNC 来源的距离以 3 种不同方式定义。结果包括来自逻辑回归的未调整均值和优势比。
约 69%在城市地点接受急性治疗的农村受益人返回离家较近的地方接受 SNC。返回家中的受益人是白人（黑人的优势比[OR]：0.69；其他种族：0.79）；男性（OR：1.07）；年龄较大（OR 年龄 85+[vs 65-69]：1.14）；距离 SNC 更远（OR：每英里增加 1.01）；离急性护理更近（OR：0.28，对数英里）；接受没有熟练护理机构的医院的急性护理（拥有 OR：0.77）和没有摆动床的医院（摆动床 OR：0.47）、高病例组合（OR：3.04）和非营利性地位（营利性 OR：0.85）。结果在“离家近”的不同定义中略有不同。
居住在农村地区、远离家接受急性治疗的医疗保险受益人更有可能在离家较远的地方接受 SNC。由于医疗保险受益人有选择接受 SNC 的地点的自由，政策制定者可能会考虑确保新的支付模式不会激励提供远离家的 SNC。
