Nursing home admissions for persons with dementia: Role of home- and community-based services.
Nursing home admissions for persons with dementia: Role of home- and community-based services.
复制标题
痴呆症患者入住疗养院：家庭和社区服务的作用。
DOI：
10.1111/1475-6773.13715
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发表时间：
2021
影响因子：
3.4
通讯作者：
Cai,Shubing
中科院分区：
文献类型：
--
作者：
Wang,Sijiu;Yan,Di;Temkin-Greener,Helena;Cai,Shubing
目的研究医疗补助家庭和社区服务（HCBS）慷慨和养老院（NH）入院的可能性与阿尔茨海默病和相关痴呆症（ADRD）的双重登记老年人及其身体和认知障碍水平之间的关系。研究设计确定了符合条件的ADRD Medicare-Medicaid双重受益人，并随访长达一年。我们构建了两个措施的HCBS慷慨，广度和强度，在县一级的老年人与ADRD。三个二元结果定义如下：样本中所有个体在随访年内的任何NH安置，高（与不高）身体损害，以及NH入院时高（与不高）认知损害。分别估计这些结果的状态固定效应和县随机效应的Logistic回归，解释个体和县水平的协变量。数据提取方法研究样本包括365，310名患有ADRD的社区居住老年双重受益人，他们在2010年10月1日至2010年12月31日期间参加了按服务付费的医疗保险和医疗补助，2012.主要发现观察到县级HCBS的广度和强度存在相当大的变化。我们发现，HCBS宽度增加10个百分点与NH入院可能性降低1.4（p< 0.01）个百分点相关。在NH入院的个体中，更大的HCBS宽度与更高水平的身体损伤相关，更大的HCBS强度与更高水平的身体和认知障碍在NH admission.ConclusionsAmong community‐dwelling ADRD，Medicaid HCBS慷慨与NH入院的可能性较低和NH入院时功能障碍较大相关。
ObjectiveTo examine the relationship between Medicaid home‐ and community‐based services (HCBS) generosity and the likelihood of nursing home (NH) admission for dually enrolled older adults with Alzheimer's disease and related dementias (ADRD) and their level of physical and cognitive impairment at NH admission.Data SourcesNational Medicare data, Medicaid Analytic eXtract, and MDS 3.0 for CY2010‐2013 were linked.Study DesignEligible Medicare–Medicaid dual beneficiaries with ADRD were identified and followed for up to a year. We constructed two measures of HCBS generosity, breadth and intensity, at the county level for older duals with ADRD. Three binary outcomes were defined as follows: any NH placement during the follow‐up year for all individuals in the sample, high (vs. not high) physical impairment, and high (vs. not high) cognitive impairment at the time of NH admission for those who were admitted to an NH. Logistic regressions with state‐fixed effects and county random effects were estimated for these outcomes, respectively, accounting for individual‐ and county‐level covariates.Data Extraction MethodsThe study sample included 365,310 community‐dwelling older dual beneficiaries with ADRD who were enrolled in fee‐for‐service Medicare and Medicaid between October 1, 2010, and December 31, 2012.Principal FindingsConsiderable variations of breadth and intensity in county‐level HCBS were observed. We found that a 10‐percentage‐point increase in HCBS breadth was associated with a 1.4 (p< 0.01)‐percentage‐point reduction in the likelihood of NH admission. Among individuals with NH admission, greater HCBS breadth was associated with a higher level of physical impairment, and greater HCBS intensity was associated with a higher level of physical and cognitive impairment at NH admission.ConclusionsAmong community‐dwelling duals with ADRD, Medicaid HCBS generosity was associated with a lower likelihood of NH admission and greater functional impairment at NH admission.