College of Health, Oregon State University, Corvallis, Oregon, USA.
School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA.
J Palliat Med. 2024 Jun;27(6):776-783. doi: 10.1089/jpm.2023.0583. Epub 2024 Feb 15.
Home health care is a core benefit of Medicare and Medicaid insurance programs and includes services to improve health, maintain health, or slow health decline. To examine the relationship between home health care use during the last three years of life and hospice use in the last six months of life among Medicare beneficiaries with and without dementia. Nationally representative retrospective cohort study. Medicare beneficiaries with at least three years of continuous enrollment who died in 2019 in the United States ( = 2,169,422). The primary outcome was hospice use, and the secondary outcome was hospice duration. The independent variable was a composite of the presence and timing of home health care initiation during the last three years of life. Home health care was used by 46.4% of Medicare beneficiaries and hospice care was used by 53.1% of beneficiaries, with 28.3% using both. Compared with beneficiaries who did not use home health care, those who started home health care before the last year of life (odds ratio [OR] = 1.57, 95% confidence interval [CI] = 1.56-1.58) or during the last year of life (OR = 1.75, 95% CI = 1.74-1.77) were more likely to use hospice. The effects were stronger in those without a diagnosis of dementia (OR = 1.92, 95% CI = 1.90-1.94) compared with those without a dementia diagnosis (OR = 1.34, 95% CI = 1.32-1.35) who started home health in the final year of life. Receiving home health care in the final years of life is associated with increased hospice use at the end-of-life in Medicare beneficiaries with and without a dementia diagnosis.
家庭保健是医疗保险和医疗补助保险计划的核心福利，包括改善健康、保持健康或减缓健康状况下降的服务。本研究旨在探讨有和没有痴呆症的医疗保险受益人的最后三年生命中家庭保健的使用与最后六个月生命中的临终关怀使用之间的关系。这是一项全国代表性的回顾性队列研究。医疗保险受益人至少连续三年参保，且在 2019 年在美国死亡（n=2,169,422）。主要结局是临终关怀的使用，次要结局是临终关怀的持续时间。自变量是生命最后三年中家庭保健开始的存在和时机的综合指标。46.4%的医疗保险受益人使用家庭保健，53.1%的受益人使用临终关怀，其中 28.3%的人同时使用这两种服务。与未使用家庭保健的受益人相比，那些在生命的最后一年之前开始家庭保健的人（优势比[OR] = 1.57，95%置信区间[CI] = 1.56-1.58）或在生命的最后一年开始家庭保健的人（OR = 1.75，95% CI = 1.74-1.77）更有可能使用临终关怀。与没有痴呆症诊断的受益人相比，这些影响在没有痴呆症诊断的受益人（OR = 1.34，95% CI = 1.32-1.35）中更强，他们在生命的最后一年开始家庭保健（OR = 1.92，95% CI = 1.90-1.94）。在有和没有痴呆症诊断的医疗保险受益人中，生命最后几年接受家庭保健与临终关怀在生命末期的使用增加有关。
