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Grabowski, David

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Grabowski

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Grabowski, David
Author's Publications: search.filters.isAuthorOfPublication.837d9d37-1d04-475a-8544-1dccdb1e968f

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    Predictors of Nursing Home Residents' Time to Hospitalization
    (Blackwell Science, 2011) O'Malley, James; Caudry, Daryl; Grabowski, David
    Objectives: To model the predictors of the time to first acute hospitalization for nursing home residents, and accounting for previous hospitalizations, model the predictors of time between subsequent hospitalizations. Data sources: Merged file from New York State for the period 1998–2004 consisting of nursing home information from the minimum dataset and hospitalization information from the Statewide Planning and Research Cooperative System. Study design: Accelerated failure time models were used to estimate the model parameters and predict survival times. The models were fit to observations from 50 percent of the nursing homes and validated on the remaining observations. Principal findings: Pressure ulcers and facility-level deficiencies were associated with a decreased time to first hospitalization, while the presence of advance directives and facility staffing was associated with an increased time. These predictors of the time to first hospitalization model had effects of similar magnitude in predicting the time between subsequent hospitalizations. Conclusions: This study provides novel evidence suggesting modifiable patient and nursing home characteristics are associated with the time to first hospitalization and time to subsequent hospitalizations for nursing home residents.
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    Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems
    (John F. Kennedy School of Government, Harvard University, 2012) Huckfeldt, Peter J; Sood, Neeraj; Escarce, Jose J; Grabowski, David; Newhouse, Joseph
    Medicare continues to implement payment reforms that shift reimbursement from fee-for-service towards episode-based payment, affecting average and marginal reimbursement. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of reimbursement; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal reimbursement with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.