Paying Family Medical Caregivers for Children's Home Healthcare in Colorado: A Working Medicaid Model.
Paying Family Medical Caregivers for Children's Home Healthcare in Colorado: A Working Medicaid Model.
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向家庭医疗护理人员支付科罗拉多州儿童家庭医疗保健费用：有效的医疗补助模式。
DOI：
10.1016/j.jpeds.2022.12.043
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Brittan,Mark
中科院分区：
文献类型：
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作者：
Foster,CarolynC;Kwon,Soyang;Blakely,Christy;Carter,Kristin;Sobotka,SarahA;Goodman,DeniseM;Agrawal,Rishi;Brittan,Mark
目的 比较接受家庭成员（家庭 CNA）和传统非家庭成员（非家庭 CNA）付费护理助理（CNA）护理的医疗复杂性儿童的特征和医疗保健使用情况。研究设计 这是一项回顾性队列研究，对象是 2017 年至 2019 年间一家家庭医疗保健机构通过科罗拉多州医疗补助付费家庭护理计划接受 CNA 护理的儿童。我们比较了家庭 CNA 组和非家庭 CNA 组之间的患者特征。使用多变量泊松回归模型来比较住院率（每年住院天数），并根据患者年龄、患者性别、护理和复杂的慢性病进行调整。结果 861 例患者中，79%（n= 680）接受家庭 CNA 护理，21%（n= 181）接受非家庭 CNA 护理。尽管有家庭 CNA 的患者接受额外护理水平护理的可能性较小（42% vs 60%，P<.01），但各组之间的患者人口统计数据和住院情况没有差异。家庭和非家庭 CNA 护理人员具有相似的特征，除了家庭 CNA 护理人员的 3 年保留率明显更高（82% 比 9%，P<.01），尽管平均时薪较低（每小时 14.60 美元比 17.60 美元，P<.01）。住院治疗的情况很少（< 10% 的患者）。在调整后的模型中，与接受非家庭 CNA 护理的患者相比，接受家庭 CNA 护理的患者每年住院时间多 1 天 (P<. 001)。结论 与非家庭 CNA 护理人员相比，付费家庭护理人员为病情复杂的儿童提供 CAN 级护理，员工保留率更高，但采用以家庭为中心的方法时，住院率略有不同。这种模式可能有助于解决劳动力短缺问题，同时也为家庭护理人员提供收入。
Objective To compare the characteristics and healthcare use of children with medical complexity who receive paid certified nursing assistant (CNA) care by a family member (family CNA) and by a traditional nonfamily member (nonfamily CNA). Study design This was retrospective cohort study of children who received CNA care through Colorado’s Medicaid paid family caregiving program between 2017 and 2019 by a home healthcare agency. We compared patient characteristics between the family CNA and nonfamily CNA groups. A multivariable Poisson regression model was used to compare hospitalization rates (days in the hospital per year), adjusting for patient age patient sex, nursing care, and complex chronic condition. Results Of 861 patients, 79%(n= 680) received family CNA care and 21%(n= 181) received nonfamily CNA care. Patient demographics and hospitalization did not differ between the groups, although patients who had family CNAs were less likely to receive additional nursing-level care (42% vs 60%, P<. 01). Family and nonfamily CNA caregivers had similar characteristics, except that family CNA caregivers had substantially better 3-year retention (82% vs 9%, P<. 01) despite lower average hourly pay ($14.60 vs $17.60 per hour, P<. 01). Hospitalizations were rare (< 10% of patients). In the adjusted model, patients who received family CNA care experienced 1 more hospitalized day per year, compared with patients who received nonfamily CNA care (P<. 001). Conclusions Paid family caregivers provided CAN-level care to children with medical complexity with a greater employee retention compared with nonfamily CNA caregivers, with marginally different hospitalization rates using a family-centered approach. This model may help address workforce shortages while also providing income to family caregivers.