Department of Mathematics and Statistics, Mississippi State University, Mississippi State, Mississippi, USA.
J Am Geriatr Soc. 2010 Jan;58(1):109-15. doi: 10.1111/j.1532-5415.2009.02614.x. Epub 2009 Dec 9.
To evaluate whether type and volume of Medicaid Home- and Community-Based Services (HCBS) waiver program are associated with risk of hospitalization and whether this association changes over time.
Prospective.
Indiana Medicaid claims data from June 2001 to December 2004.
Medicaid recipients (N=1,354) who enrolled in the Aged and Disabled waiver program between January 2002 and June 2004.
Time to hospital admission since enrollment in the HCBS waiver program, adjusted for demographics, comorbidities, prior use of health services, and volume of HCBS received, including attendant care, homemaking, and home-delivered meals.
A greater volume of attendant care, homemaking services, and home-delivered meals was associated with a lower risk of hospitalization. This effect diminished over time for attendant care and homemaking. The risk of hospitalization for subjects receiving 5 hours of attendant care per month was 54% (hazard ratio (HR)=0.46, 95% confidence interval (CI)=0.38-0.57) lower during the first month of enrollment and 20% lower by Month 10 (HR=0.80, 95% CI=0.73-0.88) than for those receiving no attendant care.
Greater volume of HCBS services was associated with lower risk of hospitalization. The findings highlight the potential importance of assessing and monitoring the volume of HCBS patients receive.
评估医疗补助计划中的家庭和社区服务（HCBS）豁免计划的类型和数量是否与住院风险相关，以及这种关联是否随时间而变化。
前瞻性研究。
2001 年 6 月至 2004 年 12 月期间印第安纳州医疗补助索赔数据。
2002 年 1 月至 2004 年 6 月期间参加 Aged and Disabled 豁免计划的医疗补助受助人（N=1354）。
自参加 HCBS 豁免计划以来的住院时间，调整了人口统计学、合并症、既往使用卫生服务和接受的 HCBS 数量，包括护理人员、家政服务和家庭送餐。
护理人员、家政服务和家庭送餐的数量越大，住院风险越低。这种效果随时间对护理人员和家政服务的影响逐渐减弱。每月接受 5 小时护理人员服务的受试者的住院风险在第一个月降低了 54%（风险比（HR）=0.46，95%置信区间（CI）=0.38-0.57），在第 10 个月降低了 20%（HR=0.80，95% CI=0.73-0.88）比没有接受护理人员服务的人。
更多的 HCBS 服务数量与较低的住院风险相关。研究结果强调了评估和监测 HCBS 患者接受服务的数量的重要性。
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