Smith Jamie M, Burgdorf Julia G, Riser Tiffany J, Ryvicker Miriam
Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
Center for Home Care Policy & Research at VNS Health, New York, New York, USA.
J Am Geriatr Soc. 2025 Feb;73(2):612-625. doi: 10.1111/jgs.19203. Epub 2024 Oct 2.
This study aims to summarize the existing research literature examining Medicare-skilled home health (HH) utilization and clinical outcomes for persons with dementia (PwD). We sought to answer the following questions: (1) How is dementia defined and classified in the HH literature? (2) What associations have been observed between dementia status and patterns of HH utilization? (3) What associations have been observed between dementia status and HH outcomes?
Using Arksey and O'Malley's framework for scoping reviews, we searched PubMed, Google Scholar, and select relevant journals for quantitative studies conducted in the United States between 2000 and 2023 examining Medicare HH use and outcomes for PwD. We describe and compare approaches to classify dementia, identify findings related to HH utilization and outcomes supported by the preponderance of evidence, and comment on existing gaps and areas of ambiguity in the literature.
Thirty-two articles met the inclusion criteria. Most used claims-based data to classify dementia, leveraged national data, and were limited to traditional Medicare beneficiaries. Studies found meaningful differences in HH utilization by dementia status; most notably, PwD were more likely to access HH without a preceding hospitalization, had longer lengths of stay, and incurred higher HH costs. Literature relating to clinical outcomes was more difficult to interpret, due to significant variation in study objectives, samples, and outcome measures which prompted more nuanced and even contradictory conclusions. There is a dearth of research identifying how specific HH care pathways (e.g., service types, visit frequency) impact outcomes for this patient population.
This review supports the understanding that PwD are a unique subpopulation of HH patients who require special attention in policy development and evaluation. Critical research is needed to examine clinical outcomes in PwD further to inform practice and improve care quality.
本研究旨在总结现有的研究文献，这些文献探讨了医疗保险认证的居家健康护理（HH）服务的使用情况以及痴呆症患者（PwD）的临床结局。我们试图回答以下问题：（1）在HH相关文献中，痴呆症是如何定义和分类的？（2）痴呆症状态与HH服务使用模式之间观察到了哪些关联？（3）痴呆症状态与HH服务结局之间观察到了哪些关联？
我们使用阿克斯和奥马利的范围综述框架，在PubMed、谷歌学术以及精选的相关期刊中搜索2000年至2023年期间在美国进行的定量研究，这些研究考察了医疗保险HH服务对PwD的使用情况和结局。我们描述并比较痴呆症的分类方法，确定有大量证据支持的与HH服务使用和结局相关的研究结果，并对文献中现有的差距和模糊领域进行评论。
32篇文章符合纳入标准。大多数研究使用基于索赔的数据对痴呆症进行分类，利用全国性数据，并且仅限于传统医疗保险受益人。研究发现，痴呆症状态不同，HH服务的使用情况存在显著差异；最显著的是，PwD在没有先前住院的情况下更有可能接受HH服务，住院时间更长，HH服务费用更高。由于研究目标、样本和结局指标存在显著差异，导致关于临床结局的文献更难解释，从而得出了更细微甚至相互矛盾的结论。缺乏关于特定HH护理途径（如服务类型、就诊频率）如何影响该患者群体结局的研究。
本综述支持这样一种认识，即PwD是HH患者中的一个独特亚群体，在政策制定和评估中需要特别关注。需要进行关键研究，进一步考察PwD的临床结局，以为实践提供信息并提高护理质量。
