Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BMC Health Serv Res. 2023 Feb 6;23(1):120. doi: 10.1186/s12913-023-09081-8.
As more Americans age in place, it is critical to understand care delivery in the home. However, data on the range of home-based services provided by Medicare is limited. We define a taxonomy of clinical care in the home funded through fee-for-service Medicare and methods to identify receipt of those services.
We analyzed Fee-for-service (FFS) Medicare claims data from a nationally-representative cohort of older adults, the National Health and Aging Trends Study (NHATS), to identify home-based clinical care. We included 6,664 NHATS enrollees age ≥ 70 and living in the community, observed an average of 3 times each on claims-linked NHATS surveys. We examined provider and service type of home-based clinical care to identify a taxonomy of 5 types: home-based medical care (physician, physician assistant, or nurse practitioner visits), home-based podiatry, skilled home health care (SHHC), hospice, and other fee-for-service (FFS) home-based care. We further characterized home-based clinical care by detailed care setting and visit types.
From 2011-2016, 17.8%-20.8% of FFS Medicare beneficiaries age ≥ 70 received Medicare-funded home-based clinical care. SHHC was the most common service (12.8%-16.1%), followed by other FFS home-based care (5.5%-6.5%), home-based medical care (3.2%-3.9%), and hospice (2.6%-3.0%). Examination of the other-FFS home-based care revealed imaging/diagnostics and laboratory testing to be the most common service.
We define a taxonomy of clinical care provided in the home, serving 1 in 5 FFS Medicare beneficiaries. This approach can be used to identify and address research and clinical care gaps in home-based clinical care delivery.
随着越来越多的美国人选择在家中养老，了解家庭护理服务至关重要。然而，关于医疗保险在家庭中提供的各种服务的数据有限。我们定义了通过医疗保险按服务收费计划（Fee-for-Service Medicare，FFS Medicare）提供的家庭临床护理的分类法，并介绍了识别这些服务的方法。
我们分析了全国代表性老年人队列——国家健康老龄化趋势研究（National Health and Aging Trends Study，NHATS）中 FFS Medicare 索赔数据，以确定家庭临床护理。我们纳入了 6664 名年龄≥70 岁、居住在社区的 NHATS 参保者，平均每人在 NHATS 调查中接受了 3 次随访。我们检查了家庭临床护理的提供者和服务类型，以确定 5 种类型的分类法：家庭医疗护理（医生、医生助理或执业护士就诊）、家庭足部护理、家庭保健护理（Skilled Home Health Care，SHHC）、临终关怀和其他 FFS 家庭护理。我们进一步通过详细的护理环境和就诊类型描述家庭临床护理的特点。
2011 年至 2016 年，17.8%至 20.8%的 FFS Medicare 受益人的年龄≥70 岁，接受了医疗保险资助的家庭临床护理。SHHC 是最常见的服务（12.8%至 16.1%），其次是其他 FFS 家庭护理（5.5%至 6.5%）、家庭医疗护理（3.2%至 3.9%）和临终关怀（2.6%至 3.0%）。对其他 FFS 家庭护理的检查显示，影像/诊断和实验室测试是最常见的服务。
我们定义了家庭中提供的临床护理分类法，服务于五分之一的 FFS Medicare 受益人。这种方法可用于识别和解决家庭临床护理服务提供方面的研究和临床护理差距。
