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Post-Acute Care Transitions for Adults With Serious Mental Illness
Post-Acute Care Transitions for Adults With Serious Mental Illness
상세정보
- 자료유형
- 학위논문 서양
- 최종처리일시
- 20260202102944
- ISBN
- 9798290913575
- DDC
- 614
- 서명/저자
- Post-Acute Care Transitions for Adults With Serious Mental Illness
- 발행사항
- [Sl] : University of Minnesota, 2024
- 발행사항
- Ann Arbor : ProQuest Dissertations & Theses, 2024
- 형태사항
- 215 p
- 주기사항
- Source: Dissertations Abstracts International, Volume: 87-02, Section: B.
- 주기사항
- Advisor: Cross, Dori A.;Shippee, Tetyana P.
- 학위논문주기
- Thesis (Ph.D.)--University of Minnesota, 2024.
- 초록/해제
- 요약Approximately 20% of traditional Medicare beneficiaries experience a hospital to SNF transition each year. Despite their frequent occurrence, transitions across levels and locations of care are incredibly error prone, poorly coordinated and communicated, and often result in cyclical patterns of hospital readmission. This is especially true for the most vulnerable and complex patients, including those with serious mental illness (SMI), who represent a growing proportion of U.S. nursing facility residents. This dissertation seeks to enhance current understanding of care transitions across the post-acute continuum for adults with SMI, placing the SNF as a central yet intermediate location of care.In Chapter One, I use Medicare claims data to examine the extent to which observed pathways to hospitals' high volume SNF partners differ for patients with versus without SMI. I find that patients with SMI experience inequitable access to their originating hospitals' network of preferred SNF partners. An effect that is significantly moderated by having a condition targeted by the hospital readmission reduction program (HRRP), where patients with both SMI and a HRRP condition are more likely to be admitted to a preferred SNF partner. In Chapter Two, I use data from a nationally representative survey of SNFs and their two top volume hospital partners to examine whether information sharing and retrieval practices differ based on SNF willingness to accept patients with complex mental and behavioral health conditions. I find that SNFs who are more willing to accept these complex patients are significantly more likely to receive complete information on behavioral, social, mental, and functional status. These SNFs are also more likely to use electronically mediated methods of information retrieval. In Chapter Three, I use Medicare claims data to examine SNF discharge patterns for patients with SMI. Specifically, I (a) describe individual, organizational, and county-level geographic factors associated with discharge from the SNF to the home/community, and (b) identify predictors and sources of variation in discharge to the home/community among patients with SMI. I find significant within-group variation among patients with SMI who discharge to the home/community versus another location in terms of key demographic and county structural characteristics. I also find that SNFs who discharge the highest proportion of their SMI patient population to the home/community are more likely to be smaller, non-profit, and more highly rated (overall, quality, and staffing).Findings from this dissertation offer important insights into the ways in which organizational relationships, specifically those between hospitals and SNFs, influence care transitions across the continuum for people with SMI.
- 일반주제명
- Public health
- 일반주제명
- Aging
- 일반주제명
- Mental health
- 키워드
- Care transitions
- 키워드
- Medicare
- 키워드
- Organizations
- 키워드
- Post-acute care
- 기타저자
- University of Minnesota Health Services Research Policy and Administration
- 기본자료저록
- Dissertations Abstracts International. 87-02B.
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
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■006m o d
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■020 ▼a9798290913575
■035 ▼a(MiAaPQ)AAI31332962
■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a614
■1001 ▼aBucy, Taylor Iris.
■24510▼aPost-Acute Care Transitions for Adults With Serious Mental Illness
■260 ▼a[Sl]▼bUniversity of Minnesota▼c2024
■260 1▼aAnn Arbor▼bProQuest Dissertations & Theses▼c2024
■300 ▼a215 p
■500 ▼aSource: Dissertations Abstracts International, Volume: 87-02, Section: B.
■500 ▼aAdvisor: Cross, Dori A.;Shippee, Tetyana P.
■5021 ▼aThesis (Ph.D.)--University of Minnesota, 2024.
■520 ▼aApproximately 20% of traditional Medicare beneficiaries experience a hospital to SNF transition each year. Despite their frequent occurrence, transitions across levels and locations of care are incredibly error prone, poorly coordinated and communicated, and often result in cyclical patterns of hospital readmission. This is especially true for the most vulnerable and complex patients, including those with serious mental illness (SMI), who represent a growing proportion of U.S. nursing facility residents. This dissertation seeks to enhance current understanding of care transitions across the post-acute continuum for adults with SMI, placing the SNF as a central yet intermediate location of care.In Chapter One, I use Medicare claims data to examine the extent to which observed pathways to hospitals' high volume SNF partners differ for patients with versus without SMI. I find that patients with SMI experience inequitable access to their originating hospitals' network of preferred SNF partners. An effect that is significantly moderated by having a condition targeted by the hospital readmission reduction program (HRRP), where patients with both SMI and a HRRP condition are more likely to be admitted to a preferred SNF partner. In Chapter Two, I use data from a nationally representative survey of SNFs and their two top volume hospital partners to examine whether information sharing and retrieval practices differ based on SNF willingness to accept patients with complex mental and behavioral health conditions. I find that SNFs who are more willing to accept these complex patients are significantly more likely to receive complete information on behavioral, social, mental, and functional status. These SNFs are also more likely to use electronically mediated methods of information retrieval. In Chapter Three, I use Medicare claims data to examine SNF discharge patterns for patients with SMI. Specifically, I (a) describe individual, organizational, and county-level geographic factors associated with discharge from the SNF to the home/community, and (b) identify predictors and sources of variation in discharge to the home/community among patients with SMI. I find significant within-group variation among patients with SMI who discharge to the home/community versus another location in terms of key demographic and county structural characteristics. I also find that SNFs who discharge the highest proportion of their SMI patient population to the home/community are more likely to be smaller, non-profit, and more highly rated (overall, quality, and staffing).Findings from this dissertation offer important insights into the ways in which organizational relationships, specifically those between hospitals and SNFs, influence care transitions across the continuum for people with SMI.
■590 ▼aSchool code: 0130.
■650 4▼aPublic health
■650 4▼aAging
■650 4▼aMental health
■653 ▼aCare transitions
■653 ▼aMedicare
■653 ▼aOrganizations
■653 ▼aPost-acute care
■653 ▼aSerious mental illness
■690 ▼a0573
■690 ▼a0769
■690 ▼a0493
■690 ▼a0347
■71020▼aUniversity of Minnesota▼bHealth Services Research, Policy and Administration.
■7730 ▼tDissertations Abstracts International▼g87-02B.
■790 ▼a0130
■791 ▼aPh.D.
■792 ▼a2024
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T17356524▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
