Post-acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status.
Post-acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status.
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患有痴呆症的医疗保险受益人的急性后护理转变和结果：与种族/民族和双重身份的关联。
DOI：
10.1111/1475-6773.14059
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发表时间：
2023
影响因子：
3.4
通讯作者：
Cai,Shubing
中科院分区：
文献类型：
--
作者：
Temkin-Greener,Helena;Yan,Di;Cai,Shubing
目的评估急性期后护理（PAC）过渡如何影响阿尔茨海默病或相关痴呆（ADRD）的少数老年人，以及双重医疗保险-医疗补助资格可能会在多大程度上减轻或加剧PAC结果的差异。我们检查了：（1）根据种族/民族和双重身份的PAC转诊;（2）与PAC相关的个人、医院和市场水平因素;（3）PAC与结果之间的关联。数据来源/研究设置我们使用了以下二级数据：主受益人摘要文件（MBSF）、医疗保险提供者分析和审查（MedPAR）、最小数据集（MDS）、地区卫生资源文件（AHRF），研究设计这项观察性研究包括619，262名社区居住的ADRD医疗保险按服务收费（FFS）受益人，他们在2017年住院。数据收集/提取方法PAC出院时前往专业护理机构（SNF），家庭保健机构或没有服务的家庭。结局为30天再入院和死亡。多元Logistic回归分析与医院随机效应（RE），按双重资格分层，fitting. PrincipalFindingsDual相关的差异显着大于种族/民族差异在PAC转换。例如，白色和黑人患者之间SNF转换概率的差异对于非亚裔和亚裔分别为3.2%和6.8%。非双重/双重白色患者之间的差异为21.6%，黑人患者之间的差异为18.0%。与家庭相比，非患者出院至SNF的30天再入院的调整后风险高5.6个百分点，但患者之间的此类风险无统计学显著差异。调整后的30天死亡率的概率更大的转换到SNF的患者和非患者，出院home.ConclusionsPAC转介和由此产生的结果与ADRD的医疗保险受益人与多层次的变量，需要纳入出院决策。
ObjectiveTo evaluate how post‐acute care (PAC) transitions affect minority older adults with Alzheimer's disease or related dementia (ADRD), and the extent to which dual Medicare‐Medicaid eligibility may attenuate or exacerbate disparities in PAC outcomes. We examined: (1) PAC referrals by race/ethnicity and dual status; (2) individual, hospital, and market‐level factors associated with PAC; (3) the association between PAC and outcomes.Data Sources/Study SettingWe used the following secondary data: Master Beneficiary Summary File (MBSF), Medicare Provider Analysis and Review (MedPAR), Minimum Data Set (MDS), Area Health Resource File (AHRF), hospital Provider of Services (POS) file, and the area deprivation index (ADI).Study DesignThis observational study consisted of 619,262 community‐residing Medicare fee‐for‐service (FFS) beneficiaries with ADRD who had a hospital stay in 2017.Data Collection/Extraction MethodsPAC discharge was to skilled nursing facilities (SNF), home health care (HHC) agencies or home without services. Outcomes were 30‐day readmission and death. Multinomial logistic regressions with hospital random effects (RE), stratified by dual eligibility, were fit.Principal FindingsDual‐related differences were significantly larger than race/ethnicity differences in PAC transitions. For example, the difference in the probability of SNF transitions between White and Black patients was 3.2% and 6.8%‐points for non‐duals and duals, respectively. The difference between non‐dual/dual White patients was 21.6% points, and among Black patients 18.0%‐points. The adjusted risk of 30‐day readmission was 5.6 percentage point higher among non‐duals discharged to SNF, compared to home, but such risk among duals was not statistically significantly different. The adjusted probabilities of 30‐day mortality were larger for duals and non‐duals who transitioned to SNF, compared to those discharged home.ConclusionsPAC referrals and the resulting outcomes for Medicare beneficiaries with ADRD are associated with multi‐level variables that need to be incorporated in discharge decision making.
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DOI：
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DOI：
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发表时间：
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期刊：
The Journal of biological chemistry
影响因子：
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Zaidi,NF;Lagenaur,CF;Abramson,JJ;Pessah,I;Salama,G
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