Implications of 2020 Skilled Home Healthcare Payment Reform for Persons with Dementia.
Implications of 2020 Skilled Home Healthcare Payment Reform for Persons with Dementia.
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DOI：
10.1111/jgs.16654
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发表时间：
2020-10
影响因子：
6.3
通讯作者：
Ornstein KA
中科院分区：
文献类型：
--
作者：
Ankuda CK;Leff B;Ritchie CS;Rahman OK;Ferreira KB;Bollens-Lund E;Ornstein KA
医疗保险家庭健康福利为越来越多的社区居民痴呆症患者提供间歇性的熟练家庭临床护理。自2020年1月1日起，家庭健康支付发生了变化：发作时间从60天缩短到30天，在社区开始的发作现在以低于机构住院后发作的费率报销。我们的目标是评估这些政策变化对这一人群的潜在影响。使用医疗保险索赔相关的国家健康和老龄化趋势研究（NHATS）的横断面研究。共有1，867名NHATS受访者在2011年至2017年期间接受了家庭健康。痴呆症是通过自我报告和通过NHATS验证的认知评估来定义的。我们描述了接受家庭健康的老年痴呆症患者与非痴呆症患者的人口统计学、社会经济学和健康特征。然后，我们评估了痴呆症与接受社区发起的家庭健康（与机构后）和家庭健康事件期间的访问时间的关联。在4年多的随访期内，50.2%的痴呆症患者使用家庭保健，而非痴呆症患者为15.3%。向痴呆症患者提供的大多数家庭健康服务是在社区发起的（61%），而向非痴呆症患者提供的服务只有37%。与没有痴呆症的人相比，痴呆症患者更有可能在发作的31至60天内接受护理。缩短发作和以较低的费率偿还社区发起的发作可能会对老年痴呆症患者中高度脆弱的人群产生不成比例的影响，他们在更长的时间内接受更多的社区发起的护理。我们的工作强调了需要更好地了解家庭健康在满足老年痴呆症患者急性和长期护理系统的差距方面的独特作用。
The Medicare home health benefit provides episodic skilled home-based clinical care to the growing population of community-dwelling persons with dementia. As of January 1, 2020, home health payment changed: episodes shortened from 60 to 30 days, and episodes initiated in the community are now reimbursed at lower rates than episodes following institutional stays. We aim to assess the potential impact of these policy changes on this population. Cross-sectional study using the Medicare claims-linked National Health and Aging Trends Study (NHATS). A total of 1,867 NHATS respondents who received home health between 2011 and 2017. Dementia was defined through both self-report and a validated cognitive assessment through NHATS. We described the demographic, socioeconomic, and health characteristics of older adults with dementia receiving home health compared with those without dementia. We then assessed the association of dementia with both receiving community-initiated home health (vs postinstitutional) and visit timing during the home health episode. Over a follow-up period of just over 4 years, 50.2% of persons with dementia used home health compared with 15.3% of persons without dementia. Most home health provided to persons with dementia was initiated in the community (61%), compared with 37% of episodes provided to persons without dementia. Persons with dementia were more likely to receive care in days 31 to 60 of the episode compared with those without dementia. Shortening episodes and reimbursing community-initiated episodes at lower rates may disproportionately impact the highly vulnerable population of older adults with dementia, who receive more community-initiated care over longer time periods. Our work highlights the need to better understand the unique role of home health in meeting gaps in both acute- and long-term care systems for older adults with dementia.
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DOI：
10.1080/15588740801909911
发表时间：
2008-01-01
期刊：
JOURNAL OF POLICY PRACTICE
影响因子：
--
作者：
Davitt, Joan K.;Marcus, Steven C.
通讯作者：
Marcus, Steven C.
影响因子：
8.4
作者：
ELLIS, RP;MCGUIRE, TG
通讯作者：
MCGUIRE, TG
影响因子：
4
作者：
Daiello, Lori A.;Gardner, Rebekah;Gravenstein, Stefan
通讯作者：
Gravenstein, Stefan
影响因子：
6.3
作者：
Bonell, Chris;Jamal, Farah;Cummins, Steven
通讯作者：
Cummins, Steven
影响因子：
--
作者：
Pierotti, Danielle
通讯作者：
Pierotti, Danielle