Salinger Maggie R, Ornstein Katherine A, Kleijwegt Hannah, Brody Abraham A, Leff Bruce, Mather Harriet, Reckrey Jennifer, Ritchie Christine S
Division of General Internal Medicine, Brown Medicine, Providence, RI.
Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, MD.
Med Care. 2025 Jan 1;63(1):27-37. doi: 10.1097/MLR.0000000000002085. Epub 2024 Oct 15.
Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation.
Develop and validate criteria that identify appropriate HBPC target populations.
A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria.
Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age ≥70) enrolled in NHATS.
Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims.
Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm's Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort.
We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC.
居家初级保健（HBPC）是针对高需求老年人的一种重要的护理模式。目前，不同的HBPC项目所针对的患者群体各不相同，这阻碍了该模式的推广和大规模评估。
制定并验证用于识别合适的HBPC目标人群的标准。
采用改良的德尔菲法，就识别HBPC目标人群的标准达成专家共识。所有标准均使用来自医疗保险理赔数据和国家健康与老龄化趋势研究（NHATS）（队列n = 21,727）的关联数据进行定义和验证。结构效度验证包括评估所选标准的人口统计学特征以及健康结果/支出情况。
德尔菲小组成员（n = 29）代表了不同的专业观点。标准在参加NHATS的社区居住医疗保险受益人（年龄≥70岁）中进行了验证。
通过德尔菲问卷选择标准。为进行结构效度验证，医疗保险受益人的社会人口学特征由NHATS中的自我报告获得，年度医疗保健支出和死亡率通过关联的医疗保险理赔数据获得。
小组成员提出了一套针对HBPC目标人群的标准算法，其中包括严重疾病、功能障碍和社会隔离的指标。该算法经德尔菲法选定的标准适用于16.8%的医疗保险受益人。与整个验证队列相比，这些HBPC目标人群的年度医疗保健成本更高[中位数（四分位间距）：10,851美元（3316，31,556）对2830美元（913，9574）]，12个月死亡率也更高[15%（95%置信区间：14，17）对5%（95%置信区间：4，5）]。
我们制定并验证了一种用于定义HBPC目标人群的算法，这表明需要增加HBPC的可及性。通过能够客观识别对HBPC服务或资源的未满足需求，该算法可促进对HBPC进行有力评估和公平推广。
