Chen Amanda C, Grabowski David C
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts, USA.
Health Serv Res. 2025 Apr;60(2):e14390. doi: 10.1111/1475-6773.14390. Epub 2024 Oct 9.
To estimate differences in facility-level outcomes between nursing homes which reached Institutional Special Needs Plan (I-SNP) maturity and those which never cared for I-SNP enrollees.
We used a difference-in-differences design to estimate the effect of I-SNP maturity, defined as having at least 33.75% of Medicare long-stayers in the nursing home enrolled in any I-SNP. Our main outcome was the hospitalization rate in each nursing home-year. Secondary outcomes included the share of residents with medication use, fall, urinary tract infection, catheter insertion, pressure ulcer, physical restraint use, increased need for help with activities of daily living (ADLs), and mortality.
This repeated cross-sectional study used 100% Medicare claims, Minimum Data Set assessments, and publicly available Medicare Advantage (MA) plan characteristics data (2004-2021). We included all MA beneficiaries who resided in US nursing homes which reached I-SNP maturity and those without I-SNP enrollees.
We identified 2530 nursing homes which reached I-SNP maturity (treated) and 9830 nursing homes without I-SNP enrollees (untreated). There were some differences observed between these nursing homes, including shares of residents who were White (76.42% vs. 84.84%) and on Medicaid (66.94% vs. 55.45%). These nursing homes were also larger on average (141.76 beds vs. 87.56 beds). From the difference-in-differences model, nursing homes which reached I-SNP maturity experienced declines of 4.1 percentage points (pp) for hospitalizations, 1.0 pp for pressure ulcers, 1.3 pp for urinary tract infections (p < 0.001) alongside increases in the need for help with ADLs, use of antipsychotics, falls, and physical restraints.
Nursing homes which reached I-SNP maturity experienced fewer hospitalizations and pressure ulcers but a decline in function and increase in other negative outcomes. I-SNPs may be a promising model to improve care for long-stay residents, but more research is needed to understand potential adverse consequences.
评估达到机构特殊需求计划（I-SNP）成熟度的疗养院与从未照护过I-SNP参保者的疗养院在机构层面的结局差异。
我们采用双重差分设计来评估I-SNP成熟度的影响，I-SNP成熟度定义为疗养院中至少33.75%的医疗保险长期居住者参保任何I-SNP。我们的主要结局是每个疗养院年度的住院率。次要结局包括使用药物、跌倒、尿路感染、导尿管插入、压疮、使用身体约束、日常生活活动（ADL）帮助需求增加以及死亡的居民比例。
这项重复横断面研究使用了100%的医疗保险理赔数据、最低数据集评估以及公开可用的医疗保险优势（MA）计划特征数据（2004 - 2021年）。我们纳入了所有居住在美国达到I-SNP成熟度的疗养院以及没有I-SNP参保者的疗养院的MA受益人。
我们确定了2530家达到I-SNP成熟度的疗养院（处理组）和9830家没有I-SNP参保者的疗养院（未处理组）。这些疗养院之间存在一些差异，包括白人居民比例（76.42%对84.84%）和参加医疗补助计划的居民比例（66.94%对55.45%）。这些疗养院平均规模也更大（141.76张床位对87.56张床位）。从双重差分模型来看，达到I-SNP成熟度的疗养院住院率下降了4.1个百分点（pp），压疮发生率下降了1.0 pp，尿路感染发生率下降了1.3 pp（p < 0.001），同时ADL帮助需求、抗精神病药物使用、跌倒和身体约束使用增加。
达到I-SNP成熟度的疗养院住院率和压疮发生率较低，但功能下降且其他负面结局增加。I-SNP可能是改善长期居住居民护理的一个有前景的模式，但需要更多研究来了解潜在的不良后果。
