Use of Post-Acute Care by Medicare Beneficiaries With a Diagnosis of Dementia
Use of Post-Acute Care by Medicare Beneficiaries With a Diagnosis of Dementia
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DOI：
10.1016/j.jamda.2021.09.016
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发表时间：
2022-04-27
影响因子：
7.6
通讯作者：
Ritter, Ashley Z.
中科院分区：
文献类型：
--
作者：
Burke, Robert E.;Xu, Yao;Ritter, Ashley Z.
目的：住院痴呆患者过渡到急性期后护理可能特别容易受到支付改革驱动的急性期后护理利用变化的影响；然而，在这一人群中使用急性后护理尚不完全清楚。我们试图描述诊断为痴呆症的医疗保险受益人在熟练护理机构（snf）和家庭健康（HH）机构的急性后护理利用情况。设计：回顾性观察性研究，使用2013 - 2016年100%的医疗保险受益人样本。环境和参与者：我们使用医疗保险提供者分析和回顾（MedPAR）确定住院和诊断，使用最小数据集确定SNF住院时间，使用结果和评估信息集确定HH发作，使用医疗保险受益人摘要文件慢性病部分确定痴呆诊断。方法：我们根据痴呆诊断、急性后护理类型（SNF vs HH）和付款人（按服务收费vs医疗保险优势）进行分层，计算急性后护理使用的总体利用率和趋势。结果：在2013年至2016年接受急性后护理的9,762,208名医疗保险服务收费受益人中，有3,155,560人（32.3%）被诊断为痴呆症。随着时间的推移，急症后护理使用率相似。更多诊断为痴呆的受益人接受急性期后护理（44.2%对27.7%），SNF护理比例更高（71.7%对49.6%）。医疗保险优惠人群的总体使用情况和趋势相似。结论和意义：三分之一接受急性后护理的按服务收费的医疗保险受益人被诊断为痴呆症，超过70%的人在SNF中接受这种护理。这些发现为评估如何最好地满足老年痴呆症患者的院后需求奠定了基础。(C) 2021 AMDA -急性和长期护理医学学会。
Objectives: Hospitalized patients with dementia transitioning to post-acute care may be particularly vulnerable to changes in post-acute care utilization driven by payment reforms; however, use of post-acute care in this population is incompletely understood. We sought to describe post-acute care utilization in skilled nursing facilities (SNFs) and from home health (HH) agencies among Medicare beneficiaries with a diagnosis of dementia.Design: Retrospective, observational study using 100% sample of Medicare beneficiaries from 2013 to 2016.Setting and Participants: We identified hospitalizations and diagnoses using Medicare Provider Analysis and Review (MedPAR), SNF stays using the Minimum Data Set, HH episodes using the Outcome and Assessment Information Set, and dementia diagnoses using the Medicare Beneficiary Summary File Chronic Conditions segment.Methods: We calculated overall utilization and trends in post-acute care use over time, stratified by dementia diagnosis, type of post-acute care (SNF vs HH), and payer (fee-for-service vs Medicare Advantage).Results: Of the 9,762,208 Medicare fee-for-service beneficiaries who received post-acute care from 2013 to 2016, 3,155,560 (32.3%) carried a diagnosis of dementia. Rates of post-acute care use were similar over time. More beneficiaries with a diagnosis of dementia received post-acute care (44.2% vs 27.7%) and proportionally more SNF care (71.7% vs 49.6%). Overall use and trends were similar in the Medicare Advantage population.Conclusions and Implications: One-third of all fee-for-service Medicare beneficiaries receiving post-acute care have a diagnosis of dementia, and more than 7 in 10 receive this care in an SNF. These findings serve as a foundation for needed evaluations of how best to meet the post-hospital needs of older adults with dementia. (C) 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.