目标:美国近一半的州医疗补助机构已经实施了有管理的长期服务和支持(MLTSS)。迄今为止,数据差距阻碍了我们对MLTSS经验的理解。我们利用一项具有新颖数据联系的全国调查,通过MLTSS计划的存在,开发了具有大量LTSS需求的老年双重注册者的概况。
方法:使用2015年国家健康与老龄化趋势研究(NHATS)的横断面观察研究,一项对65岁及以上的医疗保险受益人的全国代表性样本进行的纵向研究。
方法:样本包括275名参与者,他们自我报告了医疗补助登记,并满足了我们对显著LTSS需求的定义,这些定义是通过接受2个或更多的自我护理或行动活动(饮食,洗澡,如厕,敷料,转床,室内机动性)。
方法:双变量分析用于比较研究人口统计学差异,健康,以及MLTSS的护理情况,定义为居住在具有MLTSS计划存在的县。
结果:在大约100万(加权样本)具有重大LTSS需求的老年双重注册者中,2015年,56.2%(加权百分比)居住在MLTSS县,43.7%居住在MLTSS强制入学的县。那些生活在MLTSS地区的人更有可能是西班牙裔或其他种族和种族(50.5%对15.1%,P<.001),但不太可能生活在农村地区(8.7%vs31.4%,P<.05)或在住宅护理设施或疗养院(18.4%vs34.7%,P<0.05)。大多数人(78.5%)接受了2名或2名以上帮助者的援助,每周接受超过70小时的护理。
结论:我们的发现加强了MLTSS项目的覆盖面和填补这些项目服务对象的证据空白的重要性。
OBJECTIVE: Nearly half of all state Medicaid agencies in the United States have implemented managed long-term services and supports (MLTSS). Data gaps have inhibited our understanding of MLTSS experiences to date. We draw on a national survey with novel data linkages to develop a profile of older dual-enrollees with significant LTSS needs by MLTSS program presence.
METHODS: Cross-sectional observational study using the 2015 round of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older.
METHODS: The sample comprised 275 participants who self-reported Medicaid enrollment and met our definition of significant LTSS need as defined by receiving help with 2 or more self-care or mobility activities (eating, bathing, toileting, dressing, bed transfer, indoor mobility).
METHODS: Bivariate analyses were used to comparatively examine differences in demographic, health, and care circumstances by MLTSS, as defined by living in a county with MLTSS program presence.
RESULTS: Among approximately 1 million (weighted sample) older dual-enrollees with significant LTSS needs, 56.2% (weighted percentage) lived in counties with MLTSS and 43.7% lived in counties with mandatory MLTSS enrollment in 2015. Those living in areas with MLTSS were much more likely to be of Hispanic or other race and ethnicity (50.5% vs 15.1%, P < .001) yet less likely to live in a rural location (8.7% vs 31.4%, P < .05) or in a residential care facility or nursing home (18.4% vs 34.7%, P < .05). The majority (78.5%) received assistance from 2 or more helpers and received more than 70 hours of care per week.
CONCLUSIONS: Our findings reinforce the growing reach of MLTSS programs and importance of filling evidence gaps about who these programs are serving.