Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Geriatr Soc. 2019 Jul;67(7):1495-1501. doi: 10.1111/jgs.15968. Epub 2019 May 10.
To determine the effect of home-based primary care (HBPC) for frail older adults, operating under Independence at Home (IAH) incentive alignment on long-term institutionalization (LTI).
Case-cohort study using HBPC site, Medicare administrative data, and National Health and Aging Trends Study (NHATS) benchmarks.
Three IAH-participating HBPC sites in Philadelphia, PA, Richmond, VA, and Washington, DC.
HBPC integrated with long-term services and supports (LTSS) cases (n = 721) and concurrent comparison groups (HBPC not integrated with LTSS: n = 82; no HBPC: n = 573). Cases were eligible if enrolled at one of the three HBPC sites from 2012 to 2015. Independence at Home-qualified (IAH-Q) concurrent comparison groups were selected from Philadelphia, PA; Richmond, VA; and Washington, DC.
HBPC integrated with LTSS under IAH demonstration incentives.
Measurements include LTI rate and mortality rates, community survival, and LTSS costs.
The LTI rate in the three HBPC programs (8%) was less than that of both concurrent comparison groups (IAH-Q beneficiaries not receiving HBPC, 16%; patients receiving HBPC but not in the IAH demonstration practices, 18%). LTI for patients at each HBPC site declined over the three study years (9.9%, 9.4%, and 4.9%, respectively). Costs of home- and community-based services (HCBS) were nonsignificantly lower among integrated care patients ($2151/mo; observed-to-expected ratio = .88 [.68-1.09]). LTI-free survival in the IAH HBPC group was 85% at 36 months, extending average community residence by 12.8 months compared with IAH-q participants in NHATS.
HBPC integrated with long-term support services delays LTI in frail, medically complex Medicare beneficiaries without increasing HCBS costs.
确定在居家为基础的初级保健（HBPC）下，通过居家独立（IAH）激励机制对虚弱的老年人进行长期机构化（LTI）的效果。
使用 HBPC 站点、医疗保险管理数据和国家健康老龄化趋势研究（NHATS）基准的病例-队列研究。
宾夕法尼亚州费城、弗吉尼亚州里士满和华盛顿特区的三个参与 IAH 的 HBPC 站点。
HBPC 与长期服务和支持（LTSS）相结合的病例（n=721）和同期对照组（HBPC 与 LTSS 不结合：n=82；无 HBPC：n=573）。如果病例在 2012 年至 2015 年期间在三个 HBPC 站点之一注册，则有资格参与研究。IAH-Q 同期对照组从宾夕法尼亚州费城、弗吉尼亚州里士满和华盛顿特区选择。
在 IAH 示范激励下，HBPC 与 LTSS 相结合。
测量包括 LTI 率和死亡率、社区生存和 LTSS 成本。
三个 HBPC 项目中的 LTI 率（8%）低于同期对照组（未接受 HBPC 的 IAH-Q 受益人，16%；接受 HBPC 但不在 IAH 示范实践中的患者，18%）。在三年的研究期间，每个 HBPC 站点的 LTI 都有所下降（分别为 9.9%、9.4%和 4.9%）。在接受整合护理的患者中，家庭和社区为基础的服务（HCBS）的成本略低（每月 2151 美元；观察到的与预期比值=0.88[0.68-1.09]）。在 IAH HBPC 组中，IAH-q 参与者在 NHATS 中的 LTI 无生存时间为 36 个月时为 85%，与 NHATS 相比，平均社区居住时间延长了 12.8 个月。
在没有增加 HCBS 成本的情况下，将 HBPC 与长期支持服务相结合可以延缓虚弱、医疗复杂的医疗保险受益人的 LTI。
