Preferred Post-acute Provider Network: An Approach to Build Care Coordination Between Acute Care and Post-Acute Care Facilities
Abstract
The rate of patient discharge to post-acute care (PAC) facilities has grown abruptly in the last few years, contributing to increased healthcare costs. Although PAC benefits include better clinical outcomes and lower readmission and mortality, the variation in referral patterns raises concerns about substandard care and inflated costs. To mitigate these issues, building a preferred PAC provider network (PPN) as a partnership between acute care hospitals (ACH) and PAC providers is a long due necessity. However, the formation of this integrated network is complex involving uncertainty from various aspects. It requires a clear understanding of referral patterns to PAC providers, PAC quality performance, and PAC providers capacity and ability to serve patients from specific geographies and varying acuity levels. To carry out an investigative effort to address these complexities is the overarching theme of this research.
This research develops a data-driven standardized predictive model to help providers predict the PAC destination and quantify the risk factors influencing PAC referral. The study applies multinomial logistic regression to develop the predictive model. This study further investigates the common and interrelated risk factors for readmission and length of stay of the patients in acute hospitals with an association of PAC destinations. The last part of this research formulates an operational planning and resource adjustment model to build a PAC PPN leveraging the information and analysis extracted from the predictive referral model. The proposed model is a two-stage stochastic mixed-integer model considering the uncertainty in the number of available nurses and discharged patients. The study uses Binary first stage algorithm to solve the model and generate the decision-making parameters. The results indicate that PAC PPN could facilitate smooth transitions between care settings increasing access to PAC, which is beneficial for reducing patient cost ensuring continuous quality care.
Effective care coordination between hospital and PAC entities is crucial to ensure the avail ability of PAC service for its maximum utilization. The proposed PPN model, which involves a contract agreement between ACHs and PACs within a region, would strengthen this care coordination and thus be a powerful strategic approach in improving patient outcomes.
Subject
Preferred Provider NetworkPatient Referral
Readmission
Length of Stay
Stochastic Optimization
Citation
Sultana, Ineen (2021). Preferred Post-acute Provider Network: An Approach to Build Care Coordination Between Acute Care and Post-Acute Care Facilities. Doctoral dissertation, Texas A&M University. Available electronically from https : / /hdl .handle .net /1969 .1 /196043.