2012-2019 年美国私人住宅和家庭护理环境中按服务项目付费的医疗保险居家医疗服务的增长。
Growth of Fee-for-Service Medicare Home-Based Medical Care Within Private Residences and Domiciliary Care Settings in the U.S., 2012-2019.
机构信息
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA.
出版信息
J Am Med Dir Assoc. 2022 Oct;23(10):1614-1620.e10. doi: 10.1016/j.jamda.2022.06.014.
OBJECTIVES
Home-based medical care (HBMC) delivers physician or advanced practice provider-led medical services for patients in private residences and domiciliary settings (eg, assisted living facilities, group/boarding homes). We aimed to examine the time trends in HBMC utilization by care settings.
DESIGN
Analyses of HBMC utilization at the national and state levels during the years 2012-2019.
SETTING AND PARTICIPANTS
With Medicare public use files, we calculated the state-level utilization rate of HBMC among fee-for-service (FFS) Medicare beneficiaries, measured by visits per 1000 FFS enrollees, in private residences and domiciliary settings, both separately and combined.
METHODS
We assessed the trend of HBMC utilization over time via linear mixed models with random intercept for state, adjusting for the following state-level markers of HBMC supply and demand: number of HBMC providers, state ranking of total assisted living and residential care capacity, and the proportion of FFS beneficiaries with dementia, dual eligibility for Medicaid, receiving home health services, and Medicare Advantage.
RESULTS
Total HBMC visits in the United States increased from 3,911,778 in 2012 to 5,524,939 in 2019. The median (interquartile range) state-level HBMC utilization rate per 1000 FFS population was 67.6 (34.1-151.3) visits overall, 17.3 (7.9-41.9) visits in private residences, and 47.7 (23.1-86.6) visits in domiciliary settings. The annual percentage increase of utilization rates was significant for all care settings in crude models (3%-8%), and remained significant for overall visits and visits in domiciliary settings (2%-4%), but not in private residences.
CONCLUSIONS AND IMPLICATIONS
The national-level growth in HBMC from 2012-2019 was largely driven by a growth of HBMC occurring in domiciliary settings. To meet the needs of a growing aging population, future studies should focus efforts on policy and payment issues to address inequities in access to HBMC services for homebound older adults, and examine drivers of HBMC growth at regional and local levels.
目的
家庭医疗保健（HBMC）为私人住宅和家庭环境（例如，辅助生活设施、集体/寄宿家庭）中的患者提供由医生或高级执业医师提供的医疗服务。我们旨在研究按护理环境划分的 HBMC 使用的时间趋势。
设计
2012-2019 年对全国和州级 HBMC 使用情况进行分析。
设置和参与者
利用医疗保险公共使用文件，我们计算了按每 1000 名 FFS 参保人就诊次数计算的私人住宅和家庭环境中 HBMC 服务在 FFS 医疗保险受益人中的州级使用率，分别进行了测量。
方法
我们使用具有州随机截距的线性混合模型评估 HBMC 使用随时间的趋势，调整了 HBMC 供应和需求的以下州级标志物：HBMC 提供者人数、总辅助生活和住宅护理能力的州排名，以及 FFS 受益人的痴呆症比例、 Medicaid 的双重资格、接受家庭保健服务和 Medicare Advantage。
结果
2012 年至 2019 年，美国 HBMC 总就诊次数从 3911778 次增加到 5524939 次。每 1000 名 FFS 人群的 HBMC 使用率中位数（四分位距）为整体 67.6（34.1-151.3）次就诊、私人住宅 17.3（7.9-41.9）次就诊和家庭环境 47.7（23.1-86.6）次就诊。在粗模型中，所有护理环境的使用率年增长率均有显著意义（3%-8%），且整体就诊次数和家庭环境就诊次数仍有显著意义（2%-4%），但私人住宅就诊次数无显著意义。
结论和意义
2012-2019 年，HBMC 的全国性增长主要是由家庭环境中 HBMC 的增长推动的。为了满足不断增长的老龄化人口的需求，未来的研究应集中精力解决政策和支付问题，以解决行动不便的老年患者获得 HBMC 服务的机会不平等问题，并研究区域和地方各级 HBMC 增长的驱动因素。
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