Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
School of Social Work, University of Michigan, Ann Arbor.
J Gerontol B Psychol Sci Soc Sci. 2021 Sep 13;76(8):1679-1690. doi: 10.1093/geronb/gbaa199.
Repeated hospitalizations among older adults receiving Home- and Community-Based Services (HCBS) may indicate unmet medical and social needs. This study examined all-cause hospitalization trajectories and the association between area-level resource density for medical and social care and the trajectory group membership.
The study participants included 11,223 adults aged 60 years or older who were enrolled in public HCBS programs in Michigan between 2008 and 2012. Data sources included the Michigan interRAI-Home Care, Dartmouth Atlas of Health Care Data, the American Community Survey, and the County Business Patterns from the Census Bureau. The group-based trajectory modeling was used to identify trajectories of hospitalization over 15 months. Correlates of the trajectories were examined using multinomial logistic regression.
Four distinct hospitalization trajectory groups emerged: "never" (43.1%)-individuals who were rarely hospitalized during the study period, "increasing" (19.9%)-individuals who experienced an increased risk of hospitalization, "decreasing" (21.6%)-individuals with a decreased risk, and "frequent" (15.8%)-individuals with frequent hospitalizations. Older adults living in areas with a higher number of social service organizations for older adults and persons with disability were less likely to be on the "frequent" trajectory relative to the "decreasing" trajectory. The density of primary care physicians was not associated with the trajectory group membership.
Area-level social care resource density contributes to changes in 15-month hospitalization risks among older adult recipients of HCBS.
接受居家和社区为基础的服务（HCBS）的老年人反复住院可能表明存在未满足的医疗和社会需求。本研究考察了全因住院轨迹以及医疗和社会保健的区域资源密度与轨迹组归属之间的关系。
研究参与者包括 2008 年至 2012 年间在密歇根州参加公共 HCBS 计划的 11223 名 60 岁或以上的成年人。数据来源包括密歇根州的 interRAI-Home Care、达特茅斯医疗保健数据地图集、美国社区调查和人口普查局的县商业格局。使用基于群组的轨迹建模来确定 15 个月的住院轨迹。使用多项逻辑回归检查轨迹的相关性。
出现了四个不同的住院轨迹组：“从不”（43.1%）-在研究期间很少住院的个体，“增加”（19.9%）-住院风险增加的个体，“减少”（21.6%）-住院风险降低的个体和“频繁”（15.8%）-经常住院的个体。与“减少”轨迹相比，居住在有更多老年和残疾人士社会服务组织的地区的老年人不太可能处于“频繁”轨迹。初级保健医生的密度与轨迹组归属无关。
区域社会保健资源密度有助于改变接受 HCBS 的老年接受者 15 个月的住院风险。
