Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations.
Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations.
复制标题
医疗保险家庭健康受益者的利用率和功能结果因生活情况而异。
DOI：
10.1111/jgs.16949
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发表时间：
2021
影响因子：
6.3
通讯作者：
Li,Yue
中科院分区：
文献类型：
--
作者：
Wang,Jinjiao;Ying,Meiling;Temkin-Greener,Helena;Shang,Jingjing;Caprio,ThomasV;Li,Yue
家庭健康（HH）是医疗保险受益人可获得的一种主要类型的家庭专业护理。我们研究了生活环境和（独自在家，与他人同住，和辅助生活（AL）住所）和利用和功能结果之间的医疗保健HH收件人。和地区卫生资源文件。设置美国医疗保险认证的HH机构。参与者医疗保险受益人的全国人口≥65岁，2017年接受HH护理（N = 6，637，496）。测量结果包括住院和急诊（艾德）就诊的事件发生时间测量，和改善日常生活活动能力（ADL）从开始到结束的HH入院。非TSAL居民（12%）和患者独自住在家里（24%）在不住院和不接受艾德检查的情况下，与其他人一起生活在家中的患者相比生存时间更长（64%）。调整协变量和HH机构级随机效应，与与其他人一起生活的患者相比，AL居民的住院风险较低（风险比（HR）= 0.85，P < .001）和艾德访视（HR = 0.92，P < .001），但ADL改善较少（β= 0.29（在一个ADL中比完全独立少29%））;独居患者住院风险较低（HR = 0.94，P < .001）和艾德访视（HR = 0.93，P <0.001），但ADL改善更多（β=-0.15（在一个ADL中完全独立的15%以上））。结论在全国医疗保健HH接受者人群中，与他人同住的患者住院和艾德就诊的风险最高，而AL居民住院的风险最低，独居患者艾德就诊的风险最低，这意味着HH和AL的联合支持减少了急性护理入院。需要对与其他人一起生活在家中的HH患者进行循证干预，以避免不必要的紧急护理。
BACKGROUND/OBJECTIVESHome health (HH) is a major type of home‐based skilled care available to Medicare beneficiaries. We examined the association between living situation (home alone, home with others, and assisted living (AL) residence) and utilization and functional outcomes among Medicare HH recipients.DESIGNAnalysis of national data from the Outcome and Assessment Information Set, HH Compare, Medicare claims, and Area Health Resource Files.SETTINGMedicare‐certified HH agencies in the United States.PARTICIPANTSNational population of Medicare beneficiaries ≥65 years old who received HH care in CY 2017 (N = 6,637,496).MEASUREMENTSOutcomes included time‐to‐event measures of hospitalization and emergency department (ED) visits, and improvement in activities of daily living (ADL) from the start to the end of the HH admission.RESULTSAL residents (12%) and patients living alone at home (24%) had longer survival time without hospitalization and ED visits than patients living with others at home (64%). Adjusting for covariates and HH agency‐level random effects, and compared with patients living with others, AL residents had lower risk of hospitalization (hazard ratio (HR) = 0.85,P< .001) and ED visit (HR = 0.92,P< .001); however, less ADL improvement (β= 0.29 (29% less of total independence in one ADL)); and patients living alone had lower risk of hospitalization (HR = 0.94,P< .001) and ED visit (HR = 0.93,P< .001), yet more ADL improvement (β= −0.15 (15% more of total independence in one ADL)).CONCLUSIONIn the national population of Medicare HH recipients, patients living with others at home had the highest risk of hospitalization and ED visits, whereas AL residents had the lowest risk of hospitalization and patients living alone at home had the lowest risk of ED visits, meaning that combined support from HH and AL reduces acute care admissions. Evidence‐based interventions are needed for HH patients living with others at home to avoid unnecessary acute care use.