Home-Based Primary Care for Older Adults: Matched Case-Control Evaluation of Program’s Impact on Healthcare Utilization

IF 0.8 Q4 NURSING

Home Health Care Management and Practice Pub Date : 2023-02-14 DOI:10.1177/10848223231151975

S. M. Kling, Donn W. Garvert, A. Lessios, M. Yefimova, Marina Martin, Meera Sheffrin, M. Winget

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引用次数: 1

Abstract

Home-based Primary Care (HBPC) is an alternative model for homebound older adults. Healthcare utilization in HBPC was evaluated with a matched case-control design. Medical providers and social workers provided in-home visits. Enrolled patients were matched to controls on age, prior hospitalizations, and frailty risk. Difference-in-differences in utilization of primary care, specialty, and hospital services between 1-year pre- and 1-year post-enrollment were evaluated with hierarchical linear models. Analyses included 117 HBPC cases and 328 controls. HBPC cases had a significant increase in primary care visits compared to controls (7.8 ± 0.6; p < .0001) but significantly decreased utilization of in-clinic primary care visits (−3.2 ± 0.6; p < .0001). In-clinic specialty visits and hospital services did not differ between cases and controls (all p’s ≥ .75). Homebound patients accessed high-touch primary and social care, which is typically unachievable in clinic settings; however, additional work is needed to optimize services and target in-home care to impact healthcare utilization.

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以家庭为基础的老年人初级保健:项目对医疗保健利用影响的匹配病例对照评估

以家庭为基础的初级保健(HBPC)是居家老年人的另一种模式。采用匹配病例对照设计评估HBPC患者的医疗保健利用情况。医务人员和社会工作者提供了家访。入组患者在年龄、既往住院情况和衰弱风险方面与对照组相匹配。采用层次线性模型评估入组前1年和入组后1年对初级保健、专科和医院服务的利用差异。分析包括117例HBPC病例和328例对照。与对照组相比，HBPC病例的初级保健就诊次数显著增加(7.8±0.6;P < 0.0001)，但门诊初级保健就诊利用率显著降低(- 3.2±0.6;p < 0.0001)。门诊专科就诊和医院服务在病例和对照组之间没有差异(p值均≥0.75)。居家患者获得了高接触初级保健和社会保健，这在诊所环境中通常是无法实现的;然而，还需要做更多的工作来优化服务和目标家庭护理，以影响医疗保健的利用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Home Health Care Management and Practice NURSING-

CiteScore

2.30

自引率

18.20%

发文量

期刊介绍： Home Health Care Management & Practice is a comprehensive resource for clinicians, case managers, and administrators providing home and community based health care. Articles address diverse issues, ranging from individual patient care and case management to the human resource management and organizational operations management and administration of organizations and agencies. Regular columns focus on research, legal issues, psychosocial perspectives, accreditation and licensing, compliance, management, and cultural diversity. Specific topics include treatment, care and therapeutic techniques, cultural competence, family caregivers, equipment management, human resources, home health center.