Oregon Health & Science University, Portland, OR, USA.
Georgetown University, Washington, DC, USA.
Med Care Res Rev. 2024 Jun;81(3):271-279. doi: 10.1177/10775587231207668. Epub 2023 Oct 23.
Home- and community-based services (HCBS) users, on average, experience hospitalizations more frequently than nursing facility residents. However, little is known about state-level variation in such adverse events among these groups. Using 2018 Medicare and Medicaid claims for dual-eligible beneficiaries with Alzheimer's disease and related dementias, we described hospitalization and emergency department (ED) visit rates among HCBS users and nursing facility residents and observed substantial state-level variation. In addition, consistent with prior evidence, we found more frequent hospitalizations and ED visits among HCBS users than nursing facility residents. The magnitude of this difference varied considerably across states, and the degree of variation was greatest among beneficiaries with six or more comorbid conditions. Our findings represent a crucial initial exploration of the state-level variation in adverse events among HCBS users and nursing facility residents, paving the way for further investigations into factors that contribute to this variability.
居家和社区为基础的服务（HCBS）使用者平均比护理机构居民更频繁地住院。然而，对于这些群体中此类不良事件的州级差异知之甚少。利用 2018 年医疗保险和医疗补助计划为同时享有医疗保险和医疗补助的阿尔茨海默病和相关痴呆患者的索赔数据，我们描述了 HCBS 用户和护理机构居民的住院和急诊就诊率，并观察到了显著的州级差异。此外，与先前的证据一致，我们发现 HCBS 用户比护理机构居民更频繁地住院和急诊就诊。这种差异的幅度在各州之间有很大差异，并且在有六种或更多共病的受益人中差异最大。我们的研究结果代表了对 HCBS 用户和护理机构居民不良事件的州级差异的重要初步探索，为进一步调查导致这种变异性的因素铺平了道路。
