Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA; Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA; Affiliated Research Scientist, Regenstrief Institute, Indianapolis, IN, USA.
J Am Med Dir Assoc. 2024 Oct;25(10):105202. doi: 10.1016/j.jamda.2024.105202. Epub 2024 Aug 15.
We sought to describe national trends in hospitalization and post-acute care utilization rates in skilled nursing facilities (SNFs) and home health (HH) for both Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries, reaching up to the COVID-19 pandemic (2015-2019).
Retrospective, observational using 100% sample of Medicare Provider Analysis and Review file (MedPAR), the Medicare Beneficiary Summary File, the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS).
Medicare beneficiaries aged 66 and older enrolled in MA or TM who were hospitalized and discharged alive.
We first calculated the proportions of MA and TM beneficiaries who were hospitalized and who used any post-acute care, as well as the total number of days of post-acute care used. We also calculated the size of the post-acute care network used by TM and MA beneficiaries within each hospital in our sample and the measured quality (star ratings) of the post-acute care providers used.
We found hospitalizations, SNF stays, and HH stays were all decreasing over time in both populations. Although similar proportions of MA and TM beneficiaries received SNF or HH care, MA beneficiaries received fewer days. The largest difference we found was in the number of post-acute care providers used in TM and MA, with MA using far fewer; however, quality ratings were similar among post-acute care providers used in each program.
Together, these results suggest MA beneficiaries have fewer days in post-acute care, receive care from fewer providers of similar measured quality to TM, but have a similar number of days outside the hospital or SNF in the first 100 days after hospital discharge.
我们旨在描述医疗保险优势计划（MA）和传统医疗保险（TM）受益人的熟练护理机构（SNF）和家庭健康（HH）住院和康复后护理利用率的全国趋势，时间范围涵盖 COVID-19 大流行之前（2015-2019 年）。
回顾性观察性研究，使用 Medicare Provider Analysis and Review 文件（MedPAR）、Medicare 受益摘要文件、最小数据集（MDS）和结果和评估信息集（OASIS）的 100%样本。
年龄在 66 岁及以上、参加 MA 或 TM 的 Medicare 受益人的住院和存活出院患者。
我们首先计算了住院并接受任何康复后护理的 MA 和 TM 受益人的比例，以及使用的康复后护理总天数。我们还计算了我们样本中每家医院 TM 和 MA 受益人的康复后护理网络规模以及使用的康复后护理提供者的测量质量（星级评级）。
我们发现，在两个群体中，住院、SNF 入住和 HH 入住都随着时间的推移而减少。尽管 MA 和 TM 受益人的 SNF 或 HH 护理比例相似，但 MA 受益人的护理天数较少。我们发现的最大差异是 TM 和 MA 使用的康复后护理提供者数量，MA 使用的数量要少得多；然而，每个计划使用的康复后护理提供者的质量评级相似。
这些结果表明，MA 受益人的康复后护理天数较少，从与 TM 相似的提供者那里获得护理，接受护理的提供者数量较少，但在出院后 100 天内，他们在医院或 SNF 之外的天数相似。
