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首页> 外文期刊>The journals of gerontology.Series A. Biological sciences and medical sciences >Variations in service use in the Program of All-Inclusive Care for the Elderly (PACE): is more better?
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Variations in service use in the Program of All-Inclusive Care for the Elderly (PACE): is more better?

机译：老年人全包照顾计划（PACE）中服务使用的变化：更好吗？

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BACKGROUND: To date, there has been little empirical evidence about the relationship between service use and risk-adjusted functional outcomes among the frail, chronically ill elderly population. The Program of All-Inclusive Care for the Elderly (PACE) offers a unique model within which to investigate this relationship. We examine variation in the risk-adjusted utilization of acute, rehabilitative, and supportive services in PACE, and assess whether use of these services is associated with risk-adjusted functional outcomes. METHODS: The analytical sample included 42,252 records for 9853 individuals in 29 programs, over 3 years. Outcome was measured as change in functional status. Service use was assessed for hospital and nursing home admissions, day center attendance, therapy encounters, and personal home care. Mixed regression, generalized estimating equation (GEE) log-linear Poisson models and bootstrap procedures were used. RESULTS: We examined the marginal effect of the five services on functional status over time, having controlled for each program's risk-adjusted use of services and functional status of their enrollees. We observed a statistically significant association between hospital admissions and functional status. Sites using more hospital care had worse functional outcomes. We found no other significant relationship between functional change and service use. However, correlations between program-level measures showed that sites providing more day center care and more therapy had significantly fewer hospital admissions. CONCLUSIONS: Findings suggest that programs with high hospital use may do well to re-examine and adjust the intensity of day center care. Greater focus on service provision in this setting may enhance care coordination and lead to reductions in hospitalizations, better outcomes, and cost savings.
机译：背景：迄今为止，在脆弱，慢性病的老年人口中，关于服务使用与风险调整后的功能结局之间关系的经验证据很少。老年人全包照顾计划（PACE）提供了一个独特的模型来调查这种关系。我们检查了PACE中急性，康复和支持服务的风险调整后利用率的变化，并评估了这些服务的使用是否与风险调整后的功能结局相关。方法：分析样本包括3年中29个程序的9853个个体的42,252条记录。结果被测量为功能状态的改变。评估了医院和疗养院入院，日间出勤，治疗经历和个人家庭护理的服务使用情况。使用了混合回归，广义估计方程（GEE）的对数线性泊松模型和自举程序。结果：我们研究了五项服务随时间推移对功能状态的边际影响，并控制了每个计划的风险调整后的服务使用及其参与者的功能状态。我们观察到住院人数和功能状态之间的统计显着相关性。使用更多医院护理的站点的功能结局较差。我们发现功能更改和服务使用之间没有其他重要关系。但是，项目级措施之间的相关性表明，提供更多日间护理和更多治疗的场所的住院人数明显减少。结论：研究结果表明，医院使用率较高的计划可能对重新检查和调整日间护理强度很有效。在这种情况下，更多地关注服务提供可能会加强护理协调，并减少住院，更好的结果和节省成本。

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