What's Happening at Home A Claims-based Approach to Better Understand Home Clinical Care Received by Older Adults
What's Happening at Home A Claims-based Approach to Better Understand Home Clinical Care Received by Older Adults
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DOI：
10.1097/mlr.0000000000001267
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发表时间：
2020-04-01
期刊：
影响因子：
3
通讯作者：
Ritchie, Christine S.
中科院分区：
文献类型：
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作者：
Harrison, Krista L.;Leff, Bruce;Ritchie, Christine S.
背景资料：家庭临床护理（HCC）包括家庭医疗护理（HBMC-家庭医疗访视）和熟练的家庭医疗护理（熟练的护理或治疗访视）。超过700万老年人将受益于HCC;然而，我们对居家老年人和HCC的了解令人惊讶地少。目的：使用OptumLabs数据仓库中的索赔数据描述老年人收到的HCC。研究设计：使用商业和医疗保险优势登记者的行政索赔数据，我们描述了接受HCC和接受HBMC的亚组的发病率概况，卫生服务使用和护理协调（作为护理计划监督[CPO]）。参与者：2013-2014年连续入组12个月的300万（3，027，247）年龄≥ 65岁的成年人。措施：CPT或HCPCS代码描述HCC，HBMC和CPO接受者和护理站点，频率和提供者类型。其他措施包括人口统计学特征，临床特征和卫生保健利用。结果如下：总体而言，5%的研究人群（n= 161，801）接受了2个月以上的HCC访视;其中，46%还接受了2个月以上的HBMC访视（n= 73，638），而54%仅接受了熟练的家庭保健（n= 88，163例HCC但无HBMC）。HBMC接受者的合并症负担高（Charlson评分4.3），痴呆（35%），救护车旅行（58%），但很少有护理机构入院（4.9%）。护理协调的证据（CPO索赔）发生在30%的HCC人群，46%的HBMC和17%的熟练家庭医疗保健中。结论：在这项研究中，大约20名老年人中有1人接受了HCC; 30%或更少的人要求初级保健提供者进行护理协调。
Background: Home clinical care (HCC) includes home-based medical care (HBMC-medical visits in the home) and skilled home health care (skilled nursing or therapy visits). Over 7 million older adults would benefit from HCC; however, we know surprisingly little about homebound older adults and HCC. Objective: To describe HCC received by older adults using claims data within the OptumLabs Data Warehouse. Research Design: Using administrative claims data for commercial and Medicare Advantage enrollees, we describe morbidity profiles, health service use, and care coordination (operationalized as care plan oversight [CPO]) for people receiving HCC and the subgroup receiving HBMC. Participants: Three million adults (3,027,247) age >= 65 with 12 months of continuous enrollment 2013-2014. Measures: CPT or HCPCS codes delineated HCC, HBMC, and CPO recipients and care site, frequency, and provider type. Other measures included demographic characteristics, clinical characteristics, and health care utilization. Results: Overall, 5% of the study population (n=161,801) received 2+ months of HCC visits; of these, 46% also received 2+ HBMC visits (n=73,638) while 54% received only skilled home health (n=88,163 HCC but no HBMC). HBMC-recipients had high comorbidity burden (Charlson score 4.3), dementia (35%), and ambulance trips (58%), but few nursing facility admissions (4.9%). Evidence of care coordination (CPO claims) occurred in 30% of the HCC population, 46% of HBMC, and 17% of the skilled home health care only. Conclusions: Approximately 1 of 20 older adults in this study received HCC; 30% or less have a claim for care coordination by their primary care provider.