Improving the overall quality and star rating at the sub-acute care center

The purpose of this study is to use the knowledge, motivation, and organizational (KMO) methodological approach in improving the problem of practice of improving the star and quality rating of any post-acute care facility. Although there are several care models that are categorized under the post-acute care umbrella, the emphasis of this dissertation will focus on long-term sub-acute care. Sub-acute care was established on July 1, 1983, by the department of health care services (DHS), and it is the level of care needed for patients who do not need acute hospitalization any longer. These patients are considered medically fragile and require special services on a long-term basis in other for them to return back to their normal state of health. In healthcare, long-term care is defined as patients needing healthcare services for longer than 100 days. As the cost of healthcare in the United States (U.S.) far exceeds that of any other country in the world, healthcare advocates are requesting healthcare organizations to find ways of improving the cost and care of healthcare services provided to their customers. Medicare is the biggest payer of healthcare services in the U.S. Medicare is a government-sponsored insurance program for individuals 65 years and older, as well as for some younger adults with a disability. One of the current strategies being used to improve both care and quality is through the evaluation and rating of healthcare facilities including nursing homes. The Department of Health and Human Services (DHS) evaluates these acute and long-term facilities using an established set of criteria, and the results are sent to the Center for Medicare and Medicaid Services (CMS). It is from this inspection that a quality and star rating is provided to the nursing facility. Reimbursement, as well as punishment of the facility, is now tied to the star rating of the facility hence most long-term care facilities are looking at ways to improve their quality and star rating especially since their reimbursement for care provided to patients are linked with their rating. The star rating ranges from one star to five stars, with the five-star rating being considered as a facility providing the best quality care to its patients. In this study, I will be analyzing empirical literature and journals and providing strategies on how using the KMO model can improve the rating of a sub-acute care facility. Although there are several articles that focus on post-acute care in general, there are currently no study that focuses on sub-acute care environment that I am aware of.

本研究旨在运用知识、动机与组织（Knowledge, Motivation, and Organizational, KMO）方法论体系，攻克各类急性后护理（post-acute care）机构的星级与质量评级优化的实践难题。尽管急性后护理范畴内涵盖多种护理模式，但本论文的研究重点将聚焦于长期亚急性护理（sub-acute care）。亚急性护理于1983年7月1日由医疗服务部（Department of Health Care Services, DHS）设立，面向无需再接受急性住院治疗的患者群体。此类患者被认定为医学脆弱人群，需长期接受特殊照护以恢复至健康常态。在医疗领域，长期护理的定义为患者接受医疗服务时长超过100天的护理场景。由于美国（U.S.）的医疗成本远超全球其他所有国家，医疗领域倡导者呼吁医疗机构探索优化医疗服务成本与服务质量的路径。医疗保险（Medicare）是美国规模最大的医疗服务支付方，该项目为政府资助的保险计划，覆盖65岁及以上人群，以及部分残疾青年群体。当前用于同步提升医疗服务与质量的策略之一，是对包括养老院在内的各类医疗机构开展评估与评级。美国卫生与公众服务部（Department of Health and Human Services, DHS）依托一套既定评估标准，对各类急性与长期医疗机构开展评级，评估结果将提交至医疗保险与医疗补助服务中心（Center for Medicare and Medicaid Services, CMS）。护理机构的质量与星级评级即基于此次评估生成。如今，医疗机构的报销政策与惩戒措施均与其星级评级直接挂钩，因此多数长期护理机构正积极探索优化自身质量与星级评级的路径——尤其是在患者护理相关的报销额度与评级直接绑定的背景下。星级评级区间为1星至5星，其中5星评级代表为患者提供最高质量护理的医疗机构。本研究将对实证文献与学术期刊展开系统梳理，并提出运用KMO模型优化亚急性护理机构评级的具体策略。尽管目前已有多篇针对急性后护理的泛化研究，但据笔者所知，目前尚无专门聚焦亚急性护理场景的相关研究成果。