Jung Daniel, Ha Steph Choi Jeong, Emerson Kerstin Gerst
Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA.
Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, Georgia, USA.
J Rural Health. 2025 Jan;41(1):e12872. doi: 10.1111/jrh.12872. Epub 2024 Aug 21.
To examine the relationship between living arrangements and discharge disposition, and how this relationship differs by the rural or urban characteristics of the patient's residence among home health care patients with Alzheimer's disease and related dementia (ADRD).
This retrospective study used the 2019 Outcome and Assessment Information Set and the Master Beneficiary Summary File. Our study was based on 531,269 Medicare fee-for-service patients with ADRD. We used linear probability regression models to examine the relationship between discharge disposition (to the community vs. an institution) and living arrangements, including an interaction term for rural-urban residence.
Patients in rural areas (19.8%) were more likely to live alone than those in urban areas (15.2%). Our main results show that patients living at home with others (coefficient: -0.02, p-value < 0.001) or alone (coefficient: -0.03, p-value < 0.001) were less likely to be discharged to the community compared to patients who lived in congregate settings. Also, for patients with ADRD who lived in rural areas, living at home with others (ruralhome with others; coefficient: -0.02, p-value < 0.001) or living alone (ruralhome alone; coefficient: -0.03, p-value<0.001) were associated with additional lower probabilities of being discharged to their communities.
A multidimensional approach considering living arrangements to support home health care patients with ADRD could be critical to achieving better health outcomes. Furthermore, implementing area-specific target interventions could be important for improving the care and health of patients with ADRD as well as reducing rural-urban disparities in discharge disposition.
探讨在患有阿尔茨海默病及相关痴呆症（ADRD）的家庭医疗患者中，居住安排与出院处置之间的关系，以及这种关系如何因患者居住的农村或城市特征而有所不同。
这项回顾性研究使用了2019年结果与评估信息集以及主要受益人汇总文件。我们的研究基于531,269名参加医疗保险按服务收费的ADRD患者。我们使用线性概率回归模型来研究出院处置（回到社区与入住机构）与居住安排之间的关系，包括农村 - 城市居住的交互项。
农村地区的患者（19.8%）比城市地区的患者（15.2%）更有可能独自生活。我们的主要结果表明，与居住在集体环境中的患者相比，与他人同住家中（系数：-0.02，p值<0.001）或独自居住（系数：-0.03，p值<0.001）的患者出院回到社区的可能性较小。此外，对于居住在农村地区的ADRD患者，与他人同住家中（农村与他人同住家中；系数：-0.02，p值<0.001）或独自居住（农村独自在家；系数：-0.03，p值<0.001）与出院回到社区的额外较低概率相关。
采用多维方法考虑居住安排以支持患有ADRD的家庭医疗患者对于实现更好的健康结果可能至关重要。此外，实施针对特定地区的目标干预措施对于改善ADRD患者的护理和健康以及减少出院处置方面的城乡差距可能很重要。
