Burke Robert E, Xu Yao, Ritter Ashley Z
Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA; Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
J Am Med Dir Assoc. 2022 May;23(5):877-879.e3. doi: 10.1016/j.jamda.2021.09.016. Epub 2021 Oct 10.
Hospitalized patients with dementia transitioning to post-acute care may be particularly vulnerable to changes in post-acute care utilization driven by payment reforms; however, use of post-acute care in this population is incompletely understood. We sought to describe post-acute care utilization in skilled nursing facilities (SNFs) and from home health (HH) agencies among Medicare beneficiaries with a diagnosis of dementia.
Retrospective, observational study using 100% sample of Medicare beneficiaries from 2013 to 2016.
We identified hospitalizations and diagnoses using Medicare Provider Analysis and Review (MedPAR), SNF stays using the Minimum Data Set, HH episodes using the Outcome and Assessment Information Set, and dementia diagnoses using the Medicare Beneficiary Summary File Chronic Conditions segment.
We calculated overall utilization and trends in post-acute care use over time, stratified by dementia diagnosis, type of post-acute care (SNF vs HH), and payer (fee-for-service vs Medicare Advantage).
Of the 9,762,208 Medicare fee-for-service beneficiaries who received post-acute care from 2013 to 2016, 3,155,560 (32.3%) carried a diagnosis of dementia. Rates of post-acute care use were similar over time. More beneficiaries with a diagnosis of dementia received post-acute care (44.2% vs 27.7%) and proportionally more SNF care (71.7% vs 49.6%). Overall use and trends were similar in the Medicare Advantage population.
One-third of all fee-for-service Medicare beneficiaries receiving post-acute care have a diagnosis of dementia, and more than 7 in 10 receive this care in an SNF. These findings serve as a foundation for needed evaluations of how best to meet the post-hospital needs of older adults with dementia.
患有痴呆症的住院患者在过渡到急性后护理时，可能特别容易受到支付改革驱动的急性后护理利用变化的影响；然而，这一人群对急性后护理的使用情况尚未完全了解。我们试图描述诊断为痴呆症的医疗保险受益人在熟练护理机构（SNF）和家庭健康（HH）机构中的急性后护理利用情况。
使用2013年至2016年医疗保险受益人的100%样本进行回顾性观察研究。
我们使用医疗保险提供者分析和审查（MedPAR）确定住院情况和诊断，使用最小数据集确定SNF住院情况，使用结果和评估信息集确定HH发作情况，使用医疗保险受益人摘要文件慢性病部分确定痴呆症诊断。
我们计算了随着时间推移急性后护理使用的总体利用率和趋势，按痴呆症诊断、急性后护理类型（SNF与HH）和付款人（按服务收费与医疗保险优势计划）进行分层。
在2013年至2016年接受急性后护理的9762208名医疗保险按服务收费受益人中，3155560名（32.3%）患有痴呆症诊断。随着时间的推移，急性后护理使用率相似。更多患有痴呆症诊断的受益人接受了急性后护理（44.2%对27.7%），且按比例接受SNF护理的更多（71.7%对49.6%）。医疗保险优势计划人群中的总体使用情况和趋势相似。
在所有接受急性后护理的按服务收费医疗保险受益人中，三分之一患有痴呆症诊断，超过十分之七在SNF接受这种护理。这些发现为评估如何最好地满足痴呆症老年患者出院后需求提供了基础。
