Mesh : Humans Medicare Part C / statistics & numerical data United States Male Female Retrospective Studies Aged Home Care Services / statistics & numerical data Referral and Consultation / statistics & numerical data Patient Readmission / statistics & numerical data Aged, 80 and over Mortality / trends Hospitalization / statistics & numerical data Patient Discharge / statistics & numerical data

来  源:   DOI:10.37765/ajmc.2024.89579

Abstract:
Medicare Advantage (MA) members referred to home health after inpatient hospitalization may or may not receive these services for a variety of member- and health care system-related reasons. Our objective was to compare outcomes among MA members referred to home health following hospitalization who receive home health services vs those who do not.
Retrospective quasi-experimental study.
Following acute hospitalization, members with discharge orders to receive home health services between January 2021 and October 2022 were identified in a medical claims database consisting of MA beneficiaries. Members who received services within 30 days of discharge were balanced using inverse propensity score weighting on member- and admission-related covariates with a comparator group of members who did not receive services. Primary outcomes included mortality and readmissions in the ensuing 30, 90, and 180 days. Secondary outcomes included emergency department visits, primary care visits, and per-member per-month costs.
The home health-treated group consisted of 2115 discharges, and the untreated group consisted of 761 discharges. The treated group experienced lower mortality at 30 days (2% vs 3%, respectively; OR, 0.58; 95% CI, 0.36-0.92), 90 days (8% vs 10%; OR, 0.77; 95% CI, 0.60-0.98), and 180 days (11% vs 14%; OR, 0.81; 95% CI, 0.65-0.99). The treated group also experienced higher readmissions at 30 days (13% vs 10%; OR, 1.26; 95% CI, 1.01-1.60), 90 days (24% vs 16%; OR, 1.69; 95% CI, 1.39-2.05), and 180 days (33% vs 24%; OR, 1.52; 95% CI, 1.29-1.79).
MA members referred to home health after acute hospitalization who did not receive home health services had higher mortality.
摘要:
目的:MedicareAdvantage(MA)会员在住院后转诊到家庭保健中心,由于各种与会员和医疗保健系统相关的原因,可能会或可能不会接受这些服务。我们的目标是比较接受家庭保健服务后住院的MA成员与未接受家庭保健服务的MA成员之间的结果。
方法:回顾性准实验研究。
方法:急性住院后,在由MA受益人组成的医疗索赔数据库中确定了在2021年1月至2022年10月期间获得家庭健康服务的出院订单的成员.在出院后30天内接受服务的成员使用与成员和入院相关的协变量的反向倾向得分加权与未接受服务的比较组进行平衡。主要结果包括随后30、90和180天的死亡率和再入院率。次要结果包括急诊就诊,初级保健就诊,和每个成员每月的费用。
结果:家庭健康治疗组包括2115个出院,未治疗组761例出院.治疗组在30天的死亡率较低(2%vs3%,分别;或,0.58;95%CI,0.36-0.92),90天(8%对10%;或,0.77;95%CI,0.60-0.98),和180天(11%对14%;或,0.81;95%CI,0.65-0.99)。治疗组在30天时也有较高的再入院率(13%vs10%;OR,1.26;95%CI,1.01-1.60),90天(24%vs16%;或,1.69;95%CI,1.39-2.05),和180天(33%对24%;或,1.52;95%CI,1.29-1.79)。
结论:MA成员在急性住院后转诊至家庭保健,但未接受家庭保健服务,其死亡率较高。
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