Association Between Home Health Services and Facility Admission in Older Adults With and Without Alzheimer's Disease
Association Between Home Health Services and Facility Admission in Older Adults With and Without Alzheimer's Disease
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DOI：
10.1016/j.jamda.2019.11.002
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发表时间：
2020-05-01
影响因子：
7.6
通讯作者：
Li, Yue
中科院分区：
文献类型：
--
作者：
Wang, Jinjiao;Caprio, Thomas, V;Li, Yue
目的：评估家庭健康（HH）服务（包括专业护理（SN）、物理治疗（PT）、职业治疗、社会工作（SW）和家政助理协助）与有和无阿尔茨海默病和相关痴呆（ADRD）的Medicare患者的计划外设施入院危险之间的关联。设计：结果和评估信息集及计费记录的分析。一家为纽约州多个县提供服务的非营利性HH机构。参与者：2017年1月1日至2017年12月31日期间接受HH治疗的65岁以上成人。指标：结局是从HH开始护理到任何类型的计划外设施入院的时间，包括医院、疗养院和康复设施。独立变量包括每周强度（访视/周，小时/周）的SN，PT，职业治疗，SW和，家政助理分别援助。ADRD通过诊断（国际疾病分类，第十次修订的计费记录中的代码）和认知功能障碍评估（结果和评估信息集）确定。结果：样本（N = 6153）中，14.9%有计划外设施入院。在调整HH强度和协变量的时变效应的多变量考克斯比例风险模型中，接受最高强度的SN（3.3次访视，每周2.78小时）和PT（每周2.5次访视，每次2小时）与ADRD患者计划外住院风险分别降低54%和86%相关（n = 1525），和减少56%和90%，分别为无ADRD的患者（n = 4628）。接受任何SW与仅无ADRD的患者入院风险降低40%相关。其他HH服务并不一致的风险设施admission.Conclusions和影响：接收更高强度的SN和PT与HH患者和无ADRD之间的计划外设施入院的风险降低。政策应确保ADRD患者获得足够数量和适当组合的HH服务。(C)2019年AMDA -急性后和长期护理医学协会。
Objectives: To evaluate the association between home health (HH) services, including skilled nursing (SN), physical therapy (PT), occupational therapy, social work (SW), and homemaking aide assistance with the hazard of unplanned facility admissions among Medicare patients with and without Alzheimer's disease and related dementias (ADRD).Design: Analysis of the Outcome and Assessment Information Set and billing records.Setting: A not-for-profit HH agency serving multiple counties in New York State.Participants: Adults >65 years old who received HH from January 1, 2017 to December 31, 2017.Measures: Outcome was time from HH start of care to an unplanned facility admission of any type, including the hospital, nursing home, and rehabilitation facility. Independent variables included weekly intensity (visits/week, hours/week) of SN, PT, occupational therapy, SW, and, homemaking aide assistance separately. ADRD was identified by diagnosis (International Classification of Diseases, Tenth Revision codes in billing records) and cognitive impairment assessment (Outcome and Assessment Information Set).Results: Of the sample (N = 6153), 14.9% had an unplanned facility admission. In multivariable Cox proportional hazard models that adjusted for time-varying effects of HH intensity and covariates, receiving the highest intensity of SN (3.3 visits of 2.78 hours per week) and PT (2.5 visits of 2 hours per week) was related to up to a 54% and 86% decrease, respectively, in the hazard of unplanned facility admission among patients with ADRD (n = 1525), and decreases of 56% and 90%, respectively, among patients without ADRD (n = 4628). Receiving any SW was related to 40% decreased in the hazard of facility admission in patients without ADRD only. Other HH services were not consistently related to the risk of facility admission.Conclusions and Implications: Receiving a higher intensity of SN and PT was associated with reduced hazards of unplanned facility admission among HH patients with and without ADRD. Policies should ensure that patients with ADRD receive a sufficient amount and appropriate mix of HH services. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.