Julia G Burgdorf, Adrianne Smiley, Yolanda Barron, Jeri Goodman, Margaret V McDonald
{"title":"熟练家庭保健中的社会工作：流行程度和决定因素。","authors":"Julia G Burgdorf, Adrianne Smiley, Yolanda Barron, Jeri Goodman, Margaret V McDonald","doi":"10.1093/geroni/igaf018","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Medicare-funded home health (HH) delivers skilled care via visits to patients' homes. Social work (SW) services are included within the HH benefit and may positively affect outcomes for HH patients with complex needs. However, no prior work has quantitatively assessed SW provision during HH.</p><p><strong>Research design and methods: </strong>We examined 2018 linked HH claims, assessment, and HH agency data for a national sample of 1 372 570 Medicare HH patients. We described the prevalence, number, and timing of SW visits, compared characteristics of those who did versus did not receive SW, and modeled odds of receiving SW using a multilevel logistic model clustering at the HH agency level and adjusting for patient sociodemographic characteristics and clinical status and HH agency characteristics.</p><p><strong>Results: </strong>Just 11.3% of HH patients received SW. On average, those who received SW had a single SW visit (mean = 1.3; standard deviation [<i>SD</i>] = 0.6) occurring about a week (mean = 8.8 days; <i>SD</i> = 6.6) after HH admission. The patient-level factors most significantly associated with receiving SW included being non-Hispanic Black compared to non-Hispanic White (adjusted odds ratio [aOR]: 1.70; 95% confidence interval [CI]: 1.66-1.74), being Medicaid-enrolled (aOR: 1.26; 95% CI: 1.24-1.28), living alone (aOR: 1.31; 95% CI: 1.28-1.33), having high cognitive impairment (aOR: 2.12; 95% CI: 2.07-2.18), and exhibiting depressive symptoms (aOR: 2.17; 95% CI: 2.10-2.23). Patients also had greater odds of a SW visit if receiving care from an HH agency that was nonprofit (aOR: 1.31; 1.19-1.45) and lower odds if the HH agency had a rural service area (aOR: 0.67; 95% CI: 0.61-0.74).</p><p><strong>Discussion and implications: </strong>Findings indicate that SW access remains rare during HH and is driven by both demand-side (ie, patient needs) and supply-side (ie, agency characteristics) factors. There is a need to identify patient profiles most likely to benefit from SW services during HH and to develop strategies to mitigate agency-level barriers to access.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 5","pages":"igaf018"},"PeriodicalIF":4.9000,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082084/pdf/","citationCount":"0","resultStr":"{\"title\":\"Social Work During Skilled Home Healthcare: Prevalence and Determinants.\",\"authors\":\"Julia G Burgdorf, Adrianne Smiley, Yolanda Barron, Jeri Goodman, Margaret V McDonald\",\"doi\":\"10.1093/geroni/igaf018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Medicare-funded home health (HH) delivers skilled care via visits to patients' homes. Social work (SW) services are included within the HH benefit and may positively affect outcomes for HH patients with complex needs. However, no prior work has quantitatively assessed SW provision during HH.</p><p><strong>Research design and methods: </strong>We examined 2018 linked HH claims, assessment, and HH agency data for a national sample of 1 372 570 Medicare HH patients. We described the prevalence, number, and timing of SW visits, compared characteristics of those who did versus did not receive SW, and modeled odds of receiving SW using a multilevel logistic model clustering at the HH agency level and adjusting for patient sociodemographic characteristics and clinical status and HH agency characteristics.</p><p><strong>Results: </strong>Just 11.3% of HH patients received SW. On average, those who received SW had a single SW visit (mean = 1.3; standard deviation [<i>SD</i>] = 0.6) occurring about a week (mean = 8.8 days; <i>SD</i> = 6.6) after HH admission. The patient-level factors most significantly associated with receiving SW included being non-Hispanic Black compared to non-Hispanic White (adjusted odds ratio [aOR]: 1.70; 95% confidence interval [CI]: 1.66-1.74), being Medicaid-enrolled (aOR: 1.26; 95% CI: 1.24-1.28), living alone (aOR: 1.31; 95% CI: 1.28-1.33), having high cognitive impairment (aOR: 2.12; 95% CI: 2.07-2.18), and exhibiting depressive symptoms (aOR: 2.17; 95% CI: 2.10-2.23). Patients also had greater odds of a SW visit if receiving care from an HH agency that was nonprofit (aOR: 1.31; 1.19-1.45) and lower odds if the HH agency had a rural service area (aOR: 0.67; 95% CI: 0.61-0.74).</p><p><strong>Discussion and implications: </strong>Findings indicate that SW access remains rare during HH and is driven by both demand-side (ie, patient needs) and supply-side (ie, agency characteristics) factors. 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Social Work During Skilled Home Healthcare: Prevalence and Determinants.
Background and objectives: Medicare-funded home health (HH) delivers skilled care via visits to patients' homes. Social work (SW) services are included within the HH benefit and may positively affect outcomes for HH patients with complex needs. However, no prior work has quantitatively assessed SW provision during HH.
Research design and methods: We examined 2018 linked HH claims, assessment, and HH agency data for a national sample of 1 372 570 Medicare HH patients. We described the prevalence, number, and timing of SW visits, compared characteristics of those who did versus did not receive SW, and modeled odds of receiving SW using a multilevel logistic model clustering at the HH agency level and adjusting for patient sociodemographic characteristics and clinical status and HH agency characteristics.
Results: Just 11.3% of HH patients received SW. On average, those who received SW had a single SW visit (mean = 1.3; standard deviation [SD] = 0.6) occurring about a week (mean = 8.8 days; SD = 6.6) after HH admission. The patient-level factors most significantly associated with receiving SW included being non-Hispanic Black compared to non-Hispanic White (adjusted odds ratio [aOR]: 1.70; 95% confidence interval [CI]: 1.66-1.74), being Medicaid-enrolled (aOR: 1.26; 95% CI: 1.24-1.28), living alone (aOR: 1.31; 95% CI: 1.28-1.33), having high cognitive impairment (aOR: 2.12; 95% CI: 2.07-2.18), and exhibiting depressive symptoms (aOR: 2.17; 95% CI: 2.10-2.23). Patients also had greater odds of a SW visit if receiving care from an HH agency that was nonprofit (aOR: 1.31; 1.19-1.45) and lower odds if the HH agency had a rural service area (aOR: 0.67; 95% CI: 0.61-0.74).
Discussion and implications: Findings indicate that SW access remains rare during HH and is driven by both demand-side (ie, patient needs) and supply-side (ie, agency characteristics) factors. There is a need to identify patient profiles most likely to benefit from SW services during HH and to develop strategies to mitigate agency-level barriers to access.
期刊介绍：
Innovation in Aging, an interdisciplinary Open Access journal of the Gerontological Society of America (GSA), is dedicated to publishing innovative, conceptually robust, and methodologically rigorous research focused on aging and the life course. The journal aims to present studies with the potential to significantly enhance the health, functionality, and overall well-being of older adults by translating scientific insights into practical applications. Research published in the journal spans a variety of settings, including community, clinical, and laboratory contexts, with a clear emphasis on issues that are directly pertinent to aging and the dynamics of life over time. The content of the journal mirrors the diverse research interests of GSA members and encompasses a range of study types. These include the validation of new conceptual or theoretical models, assessments of factors impacting the health and well-being of older adults, evaluations of interventions and policies, the implementation of groundbreaking research methodologies, interdisciplinary research that adapts concepts and methods from other fields to aging studies, and the use of modeling and simulations to understand factors and processes influencing aging outcomes. The journal welcomes contributions from scholars across various disciplines, such as technology, engineering, architecture, economics, business, law, political science, public policy, education, public health, social and psychological sciences, biomedical and health sciences, and the humanities and arts, reflecting a holistic approach to advancing knowledge in gerontology.
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