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Association Between Home Health Services and Facility Admission in Older Adults With and Without Alzheimer's Disease
Journal of the American Medical Directors Association ( IF 7.6 ) Pub Date : 2020-05-01 , DOI: 10.1016/j.jamda.2019.11.002
Jinjiao Wang 1 , Thomas V Caprio 2 , Adam Simning 3 , Jingjing Shang 4 , Yeates Conwell 3 , Fang Yu 5 , Yue Li 6
Affiliation  

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.

中文翻译:

患有和不患有阿尔茨海默病的老年人的家庭健康服务与设施入院之间的关联

目的 评估家庭健康 (HH) 服务,包括熟练护理 (SN)、物理治疗 (PT)、职业治疗、社会工作 (SW) 和家政助理协助与 Medicare 患者意外入院风险之间的关联。并且没有阿尔茨海默病和相关痴呆症(ADRD)。结果和评估信息集和计费记录的设计分析。设立一个为纽约州多个县提供服务的非营利 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 岁以上的成年人。 测量结果是从 HH 开始护理到意外入住任何类型的设施(包括医院、疗养院和康复设施)的时间。自变量包括 SN、PT、职业治疗、SW 和家政助手协助分开。ADRD 通过诊断(国际疾病分类,账单记录中的第十修订版代码)和认知障碍评估(结果和评估信息集)来确定。结果 在样本 (N = 6153) 中,14.9% 的人意外入院。在针对 HH 强度和协变量的时变效应进行调整的多变量 Cox 比例风险模型中,接受最高强度的 SN(每周 2.78 小时的 3.3 次访问)和 PT(每周 2 小时的 2.5 次访问)与高达ADRD 患者(n = 1525)意外入院的风险分别降低 54% 和 86%,非 ADRD 患者(n = 4628)分别降低 56% 和 90%。接受任何 SW 与仅无 ADRD 的患者入院风险降低 40% 相关。其他 HH 服务与入院风险不一致。结论和意义 在患有和不患有 ADRD 的 HH 患者中,接受更高强度的 SN 和 PT 与降低意外入院的风险相关。政策应确保 ADRD 患者获得足够数量和适当组合的 HH 服务。
更新日期:2020-05-01
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