Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA.
J Am Med Dir Assoc. 2012 Feb;13(2):189.e9-189.e13. doi: 10.1016/j.jamda.2011.06.001. Epub 2011 Jul 18.
This study examined the impact of hospice enrollment on the probabilities of hospital and nursing home admissions among a sample of frail dual-eligible assisted living (AL) residents.
The study used a retrospective cohort design. We estimated bivariate probit models with 2 binary outcome variables: any hospital admissions and any nursing home admissions after assisted living enrollment.
A total of 328 licensed AL communities accepting Medicaid waivers in Florida.
We identified all newly admitted dual-eligible AL residents in Florida between January and June of 2003 who had complete state assessment data (n = 658) and followed them for 6 to 12 months.
Using the Andersen behavioral model, predisposing (age, gender, race), enabling (marital status, available caregiver, hospice use), and need (ADL/IADL, comorbidity conditions, and incontinence) characteristics were included as predictors of 2 binary outcomes (hospital and nursing home admission). Demographics, functional status, and caregiver availability were obtained from the state client assessment database. Data on diagnosis and hospital, nursing home, and hospice use were obtained from Medicare and Medicaid claims. Death dates were obtained from the state vital statistics death certificate data.
The mean age of the study sample was 81.5 years. Three-fourths were female and 63% were White. The average resident had a combined ADL/IADL dependency score of 11.49. Fifty-eight percent of the sample had dementia. During the average 8.9-month follow-up period, 6.8% were enrolled in hospice and 10.2% died. Approximately 33% of the sample had been admitted into a hospital and 20% had been admitted into a nursing home. Bivariate probit models simultaneously predicting the likelihood of hospital and nursing home admissions showed that hospice enrollment was associated with lower likelihood of hospital (OR = 0.24, P < .01) and nursing home admissions (OR = 0.56, P < .05). Significant predictors of hospital admissions included higher Charlson Comorbidity Index score and incontinence. Predictors of nursing home admissions included higher Charlson Comorbidity Index score, the absence of available informal caregiver, and incontinence.
Hospice enrollment was associated with a lower likelihood of hospital and nursing home admissions, and, thus, may have allowed AL residents in need of palliative care to remain in the AL community. AL providers should support and facilitate hospice care among older frail dual-eligible AL residents. More research is needed to examine the impact of hospice care on resident quality of life and total health care expenditures among AL residents.
本研究考察了在衰弱的双重资格辅助生活（AL）居民样本中，临终关怀登记对住院和疗养院入院概率的影响。
该研究使用回顾性队列设计。我们使用了两个二元结果变量的二元 Probit 模型：任何住院和任何疗养院入院在辅助生活后的入学。
佛罗里达州共有 328 个获得许可的接受医疗补助豁免的 AL 社区。
我们确定了所有 2003 年 1 月至 6 月期间在佛罗里达州新入住的双重合格 AL 居民，他们有完整的州评估数据（n=658），并对他们进行了 6 至 12 个月的随访。
使用安德森行为模型，将倾向（年龄、性别、种族）、赋权（婚姻状况、可用照顾者、临终关怀使用）和需要（ADL/IADL、合并症状况和尿失禁）特征作为两个二元结果（住院和疗养院入院）的预测因素。人口统计学、功能状态和照顾者可用性从州客户评估数据库获得。诊断、医院、疗养院和临终关怀使用的数据从医疗保险和医疗补助索赔中获得。死亡日期从州死亡证明数据中获得。
研究样本的平均年龄为 81.5 岁。四分之三为女性，63%为白人。平均居民的 ADL/IADL 依赖性评分平均为 11.49。58%的样本患有痴呆症。在平均 8.9 个月的随访期间，6.8%的人登记接受临终关怀，10.2%的人死亡。样本中约有 33%的人住院，20%的人住院。二元 Probit 模型同时预测了住院和疗养院入院的可能性，结果表明临终关怀登记与较低的住院（OR=0.24，P<.01）和疗养院入院（OR=0.56，P<.05）的可能性相关。住院的显著预测因素包括较高的 Charlson 合并症指数评分和尿失禁。疗养院入院的预测因素包括较高的 Charlson 合并症指数评分、缺乏可用的非正式照顾者和尿失禁。
临终关怀登记与较低的住院和疗养院入院率相关，因此，可能允许需要姑息治疗的衰弱的双重资格辅助生活居民留在辅助生活社区。辅助生活提供者应支持和促进年龄较大的衰弱的双重资格辅助生活居民接受临终关怀。需要更多的研究来检查临终关怀对辅助生活居民生活质量和总医疗保健支出的影响。
