Acute, Post-acute, and Primary Care Utilization in a Home-Based Primary Care Program During COVID-19
Acute, Post-acute, and Primary Care Utilization in a Home-Based Primary Care Program During COVID-19
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DOI：
10.1093/geront/gnaa158
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发表时间：
2021-02-01
期刊：
影响因子：
5.7
通讯作者：
Poku, Asantewaa
中科院分区：
文献类型：
--
作者：
Abrashkin, Karen A.;Zhang, Jenny;Poku, Asantewaa
背景和目标：患有多种合并症的老年人因 2019 年冠状病毒病 (COVID-19) 而住院率较高且预后较差。 COVID-19 大流行期间高级疾病管理 (AIM) 计划人员的护理利用变化尚不清楚。本研究的目的是描述大流行之前和期间在 COVID-19 大流行中心居家 AIM 患者的护理利用率的变化。研究设计和方法：使用描述性统计和差异检验来比较护理利用率，包括急诊室 (ED) 和住院患者入院、急性和亚急性康复以及大流行期间 AIM 计划的利用率与 1 年前的比率。结果：参与者 (n = 1,468) 的急性和急性后利用率下降2020 年 3 月至 5 月与一年前相比（n = 1,452），而 AIM 计划资源的利用率仍然很高。比较 2019 年和 2020 年，每 1,000 名登记者的急诊就诊次数分别为 109 例与 44 例 (p < .001)，住院患者分别为 213 例与 113 例 (p < .001)，康复机构住院例例分别为 56 例与 31 例 (p = .014)； AIM 计划家访次数为 1,935 次与 276 次 (p < .001)，远程访问（远程医疗/电话）为 0 次与 1,079 次 (p < .001)，所有其他电话接触次数分别为 3,032 次与 5,062 次 (p < .001)。家庭临终关怀入院人数/1,000 增加：16-31 (p = .011)。 讨论和启示：我们的结果表明，与 1 年前相比，在 COVID-19 大流行期间，一群居家老年人中，急性和急性后利用率下降，同时与 AIM 计划保持高水平的联系。虽然还需要进一步研究，但我们的结果表明，AIM 计划可以在大流行期间在家庭环境中为这一人群提供支持。
Background and Objectives: Older adults with multiple comorbidities experience high rates of hospitalization and poor outcomes from Coronavirus Disease 2019 (COVID-19). Changes in care utilization by persons in advanced illness management (AIM) programs during the COVID-19 pandemic are not well known. The purpose of this study was to describe changes in care utilization by homebound AIM patients in an epicenter of the COVID-19 pandemic before and during the pandemic.Research Design and Methods: Descriptive statistics and tests of differences were used to compare care utilization rates, including emergency department (ED) and inpatient admissions, acute and subacute rehabilitation, and AIM program utilization during the pandemic with rates 1 year prior.Results: Acute and post-acute utilization for enrollees (n = 1,468) decreased March-May 2020 compared to 1 year prior (n = 1,452), while utilization of AIM program resources remained high. Comparing 2019 and 2020, ED visits/1,000 enrollees were 109 versus 44 (p < .001), inpatient admissions 213 versus 113 (p < .001), and rehabilitation facility admissions 56 versus 31 (p = .014); AIM program home visits were 1,935 versus 276 (p < .001), remote visits (telehealth/telephonic) 0 versus 1,079 (p < .001), and all other phone touches 3,032 versus 5,062 (p < .001). Home hospice admissions/1,000 increased: 16-31 (p = .011).Discussion and Implications: Our results demonstrate decreased acute and post-acute utilization, while maintaining high levels of connectedness to the AIM program, among a cohort of homebound older adults during the COVID-19 pandemic compared with 1 year prior. While further study is needed, our results suggest that AIM programs can provide support to this population in the home setting during a pandemic.