在生命的最后七天中，按居住地划分的 Medicare 逝者接受临终关怀探访强度的二次分析。
A Secondary Analysis of the Intensity of Hospice Visits Among Medicare Decedents in the Last Seven Days of Life by Place of Residence.
机构信息
1498Centers for Medicare & Medicaid Services, Baltimore, MD, USA.
出版信息
Am J Hosp Palliat Care. 2022 Nov;39(11):1274-1280. doi: 10.1177/10499091211064848. Epub 2021 Dec 21.
BACKGROUND
In 2016, Medicare finalized the Service Intensity Add-on (SIA) payment policy to increase the intensity of hospice registered nurse (RN) or social worker (SW) visits in the last 7 days of life. The research objective was to compare the intensity of hospice RN or SW visits in the last 7 days of life among older decedents who received a hospice visit, while residing in a traditional home, an assisted living facility, or long-term nursing home.
METHODS
A retrospective analysis using 2016-2018 Medicare data of decedents 65 years or older (n= 2 067 863) related to the Medicare SIA payment policy. Intensity was defined as the number and duration of hospice RN or SW visits in the last 7 days of life using Medicare claims code G0299 and G0155.
RESULTS
Regression results suggest that decedents who received a SIA related visit while residing in an assisted living facility, had on average a slightly longer duration of hospice RN visits in the last 7 days of life, compared to decedents residing in a traditional home, after controlling for demographics and other factors (P<.0001). The duration of hospice RN visits remained unchanged among decedents who received a SIA visit in 2017 or 2018, when compared to 2016 (P <.0001). Overall the average number of hospice SW visits did not differ by place of residence among decedents who received a SIA visit.
CONCLUSIONS
Among decedents who received a SIA related visit, the duration of hospice RN visits were slightly different by place of residence.
背景
2016 年，医疗保险最终确定了服务强度附加（SIA）支付政策，以增加临终关怀注册护士（RN）或社会工作者（SW）在生命最后 7 天的探访强度。研究目的是比较在生命最后 7 天接受临终关怀探访时，居住在传统家庭、辅助生活设施或长期护理院的老年死者的临终关怀 RN 或 SW 探访强度。
方法
使用 2016-2018 年与医疗保险 SIA 支付政策相关的 65 岁及以上死者（n=2067863）的医疗保险数据进行回顾性分析。强度定义为生命最后 7 天内临终关怀 RN 或 SW 探访的次数和持续时间，使用医疗保险索赔代码 G0299 和 G0155。
结果
回归结果表明，与居住在传统家庭的死者相比，居住在辅助生活设施的死者在接受与 SIA 相关的探访时，生命最后 7 天内临终关怀 RN 探访的持续时间平均略长，在控制了人口统计学和其他因素后（P<.0001）。与 2016 年相比，2017 年或 2018 年接受 SIA 探访的死者的临终关怀 RN 探访持续时间没有变化（P<.0001）。总体而言，接受 SIA 探访的死者在居住地点之间的临终关怀 SW 探访次数没有差异。
结论
在接受 SIA 相关探访的死者中，临终关怀 RN 探访的持续时间因居住地点而异。
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