Rivera-Hernandez Maricruz, Matos-Moreno Amilcar, Ferdows Nasim B, Kumar Amit
Center for Gerontology and Healthcare Research at Brown University School of Public Health, Providence, RI, USA.
Center for Social epidemiology and Population Health, University of Michigan, Ann Arbor, MI, USA.
J Am Med Dir Assoc. 2021 Mar;22(3):712-716.e4. doi: 10.1016/j.jamda.2020.11.005. Epub 2020 Dec 8.
The purpose of the study is to contribute to the literature regarding post-acute nursing home utilization and quality indicators among Medicare beneficiaries in Puerto Rico compared with the US mainland.
Medicare data from 2015 to 2017 was used to identify new discharges to skilled nursing facilities (SNFs) using the Minimum Data Set and the Medicare Provider Analysis and Review.
Post-acute care patients admitted to SNFs in Puerto Rico and the United States.
Our final cohort included 4,732,222 beneficiaries from Puerto Rico and the United States enrolled in Medicare fee-for-service or Medicare Advantage programs admitted to an SNF (N = 15,197) following an acute hospital stay. We compared demographic, clinical, and facility-level characteristics among patients in Puerto Rico and the United States. We also described 2 quality indicators among these groups: (1) 30-day rehospitalization rates and (2) successful discharge from the facility to the community.
Medicare patients in Puerto Rico were physically and cognitively healthier than patients in the United States. Puerto Ricans were also more likely to be admitted to lower quality nursing homes than US patients (2.5 vs 3.4). Finally, Puerto Ricans had higher rates of successful discharge to the community [17.6, 95% confidence interval (CI) 13.0-22.3], but higher 30-day rehospitalization rates compared with US patients (11.2, 95% CI 6.2-16.3). These differences were consistent even when comparing these quality outcomes among Puerto Ricans to US Hispanics only.
SNFs in the United States and Puerto Rico are now receiving financial penalties for high readmission rates. Currently, Medicare does not measure readmission rates for Medicare Advantage patients-even though some states, including Puerto Rico, have a high proportion of Medicare Advantage beneficiaries. As Medicare Advantage enrollment continues to increase, our results highlight the importance of measuring performance among Medicare Advantage patients and assessing disparities in quality of post-acute care among patients in Puerto Rico and the United States.
本研究旨在补充有关波多黎各与美国本土医疗保险受益人中急性后期疗养院利用率和质量指标的文献。
使用2015年至2017年的医疗保险数据，通过最低数据集和医疗保险提供者分析与审查来确定转至专业护理机构（SNFs）的新出院患者。
入住波多黎各和美国SNFs的急性后期护理患者。
我们的最终队列包括4732222名来自波多黎各和美国的医疗保险受益人，他们参加了医疗保险按服务付费或医疗保险优势计划，在急性住院后入住了SNF（N = 15197）。我们比较了波多黎各和美国患者的人口统计学、临床和机构层面特征。我们还描述了这些群体中的两个质量指标：（1）30天再住院率和（2）从机构成功出院至社区。
波多黎各的医疗保险患者在身体和认知方面比美国患者更健康。波多黎各人也比美国患者更有可能入住质量较低的疗养院（2.5对3.4）。最后，波多黎各人成功出院至社区的比例更高[17.6，95%置信区间（CI）13.0 - 22.3]，但与美国患者相比，30天再住院率更高（11.2，95%CI 6.2 - 16.3）。即使仅将波多黎各人的这些质量结果与美国西班牙裔进行比较，这些差异也是一致的。
美国和波多黎各的SNFs目前因高再入院率而受到经济处罚。目前，医疗保险并未衡量医疗保险优势计划患者的再入院率——尽管包括波多黎各在内的一些州医疗保险优势受益人比例很高。随着医疗保险优势计划参保人数持续增加，我们的结果凸显了衡量医疗保险优势计划患者绩效以及评估波多黎各和美国患者急性后期护理质量差异的重要性。
