Place of care in the last three years of life for Medicare beneficiaries.
Place of care in the last three years of life for Medicare beneficiaries.
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DOI：
10.1186/s12877-023-04610-w
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发表时间：
2024-01-25
期刊：
影响因子：
4.1
通讯作者：
Jarrin, Olga F.
中科院分区：
文献类型：
--
作者：
Lin, Haiqun;Grafova, Irina B.;Zafar, Anum;Setoguchi, Soko;Roy, Jason;Kobylarz, Fred A.;Halm, Ethan A.;Jarrin, Olga F.
大多数老年人更喜欢衰老；但是，患有晚期疾病的患者通常需要机构护理。了解护理轨迹模式可能会为以患者为中心的护理计划和健康政策决策提供信息。这项研究的目的是表征生命的最后三年中护理轨迹的特征。
分析了链接的行政，索赔和评估数据，分析了2018年去世的美国医疗保险受益人的10％随机样本队列，享年50岁或五十岁以上，并在他们的最后五年中不断招募Medicare。一种基于小组的轨迹建模方法用于基于机构护理（医院住院或熟练的护理设施）和熟练的家庭护理（家庭保健和家庭保健和家庭临终关怀）的比例来对受益人进行分类。评估了小组成员与社会人口统计学和临床预测因子之间的关联。
该分析队列包括199,828名Medicare受益人。确定了九个护理轨迹组，分为三个集群：家庭，熟练的家庭护理和机构护理。超过一半（59％）的受益人都在家庭群体中，过去三年大部分时间都在家中，熟练的家庭护理和机构护理使用集中在生命的最后一季度。四分之一（27％）的受益人在熟练的家庭护理集群中，大量使用熟练的家庭保健和家庭临终关怀；其余14％的人在机构集群中，大量使用疗养院和住院护理。与熟练的家庭护理和机构护理集群相关的因素是女性，黑人种族，诊断痴呆症和医疗补助保险。在南部各州，熟练的家庭护理的扩展使用更为普遍，中西部各州的扩展机构护理更为普遍。
这项研究确定了不同的护理轨迹模式，这些模式在生命的最后三年中的机构和熟练家庭护理的时间和熟练的家庭护理持续时间有所不同。临床，社会区和健康政策因素影响了患者接受护理的地方。我们的发现可以帮助您提供个人和社会护理计划。
在线版本包含的补充材料可在10.1186/s12877-023-04610-W上获得。
Most older adults prefer aging in place; however, patients with advanced illness often need institutional care. Understanding place of care trajectory patterns may inform patient-centered care planning and health policy decisions. The purpose of this study was to characterize place of care trajectories during the last three years of life. Linked administrative, claims, and assessment data were analyzed for a 10% random sample cohort of US Medicare beneficiaries who died in 2018, aged fifty or older, and continuously enrolled in Medicare during their last five years of life. A group-based trajectory modeling approach was used to classify beneficiaries based on the proportion of days of institutional care (hospital inpatient or skilled nursing facility) and skilled home care (home health care and home hospice) used in each quarter of the last three years of life. Associations between group membership and sociodemographic and clinical predictors were evaluated. The analytic cohort included 199,828 Medicare beneficiaries. Nine place of care trajectory groups were identified, which were categorized into three clusters: home, skilled home care, and institutional care. Over half (59%) of the beneficiaries were in the home cluster, spending their last three years mostly at home, with skilled home care and institutional care use concentrated in the final quarter of life. One-quarter (27%) of beneficiaries were in the skilled home care cluster, with heavy use of skilled home health care and home hospice; the remaining 14% were in the institutional cluster, with heavy use of nursing home and inpatient care. Factors associated with both the skilled home care and institutional care clusters were female sex, Black race, a diagnosis of dementia, and Medicaid insurance. Extended use of skilled home care was more prevalent in southern states, and extended institutional care was more prevalent in midwestern states. This study identified distinct patterns of place of care trajectories that varied in the timing and duration of institutional and skilled home care use during the last three years of life. Clinical, socioregional, and health policy factors influenced where patients received care. Our findings can help to inform personal and societal care planning. The online version contains supplementary material available at 10.1186/s12877-023-04610-w.
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