Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2021 Jul;69(7):1887-1895. doi: 10.1111/jgs.17138. Epub 2021 Mar 26.
BACKGROUND/OBJECTIVES: Medicare-certified home health agencies are required to offer family caregiver training, but little is known regarding the potential impact of this training on outcomes during home health care. We estimate the proportion of family caregivers assisting Medicare home health patients who have unmet training needs and examine whether these unmet training needs are associated with older adults' risk of acute care utilization during home health care.
Observational, nationally representative cohort study.
Linked National Health and Aging Trends Study, Outcome and Assessment Information Set (OASIS), Medicare Provider of Services file, and Medicare claims data from 2011 to 2016.
Thousand two hundred seventeen (weighted n = 5,870,905) community-living Medicare beneficiaries who received home health care between 2011 and 2016.
Family caregivers' unmet training needs measured from OASIS and Medicare claims; home health patients' acute care utilization (including emergency department use and hospitalization) measured from OASIS.
Rates of unmet need for training varied by activity, from 8.2% of family caregivers assisting with household chores to 16.0% assisting with self-care tasks. After controlling for older adult and home health provider characteristics, older adults whose family caregivers had an unmet need for training with any caregiving activity were twice as likely to incur acute care utilization during their home health episode (adjusted odds ratio [aOR]: 2.01, 95% confidence interval [CI]: 1.20-3.38). This relationship held across specific caregiving activities including household chores (aOR: 1.98; 95% CI: 1.13-3.46), medication management (aOR: 2.50; 95% CI: 1.46-4.26), patient supervision (aOR: 2.92; 95% CI: 1.36-6.24), and self-care tasks (aOR: 3.11; 95% CI: 1.62-6.00).
Unmet training needs among family caregivers are associated with greater likelihood of acute care utilization among Medicare beneficiaries receiving home health care. Identifying and addressing family caregivers' training needs may reduce older adults' risk of acute care utilization during home health care.
背景/目的：医疗保险认证的家庭保健机构被要求提供家庭护理人员培训，但对于这种培训对家庭保健期间的结果的潜在影响知之甚少。我们估计在为医疗保险家庭保健患者提供帮助的家庭护理人员中，有多少人存在未满足的培训需求，并研究这些未满足的培训需求是否与老年人在家庭保健期间急性护理利用的风险相关。
观察性、全国代表性队列研究。
2011 年至 2016 年期间，通过国家健康老龄化趋势研究、结果和评估信息集（OASIS）、医疗保险服务提供者文件和医疗保险索赔数据进行链接。
2011 年至 2016 年间接受家庭保健的 1217 名（加权 n=5870905）居住在社区的医疗保险受益人。
从 OASIS 和医疗保险索赔中测量家庭护理人员的未满足培训需求；从 OASIS 中测量家庭保健患者的急性护理利用情况（包括急诊使用和住院）。
家庭护理人员在不同活动中的培训需求未得到满足的比例各不相同，从 8.2%的家庭护理人员帮助做家务到 16.0%的家庭护理人员帮助自理。在控制了老年人和家庭保健提供者的特征后，家庭护理人员有任何护理活动的培训需求未得到满足的老年人在家庭保健期间发生急性护理利用的可能性是两倍（调整后的优势比 [aOR]：2.01，95%置信区间 [CI]：1.20-3.38）。这种关系适用于包括家务（aOR：1.98；95% CI：1.13-3.46）、药物管理（aOR：2.50；95% CI：1.46-4.26）、患者监督（aOR：2.92；95% CI：1.36-6.24）和自理任务（aOR：3.11；95% CI：1.62-6.00）在内的特定护理活动。
家庭护理人员未满足的培训需求与医疗保险接受家庭保健的受益人的急性护理利用的可能性增加有关。确定和解决家庭护理人员的培训需求可能会降低老年人在家庭保健期间急性护理利用的风险。
