Reckrey Jennifer M, Russell David, Burgdorf Julia G, Aldridge Melissa
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
VNS Health Center for Home Care Policy and Research, VNS Health, New York, NY, USA; Department of Sociology, Appalacian State University, Boone, NC, USA.
J Am Med Dir Assoc. 2025 May;26(5):105535. doi: 10.1016/j.jamda.2025.105535. Epub 2025 Mar 17.
Despite growing interest in expansion of consumer- (or self-) directed models of Medicaid-funded personal care, research characterizing program use is limited. We leverage health plan and claims data from a large health plan in New York to examine (1) trends in use of consumer-directed care and (2) the impact of the COVID-19 pandemic on consumer-directed care use.
Retrospective cohort study.
All individuals enrolled in a large, New York health plan who received Medicaid-funded personal care between January 2017 and December 2022 (n = 47,216).
Proportion of enrollees receiving consumer-directed care during each month and year was calculated for all enrollees and the subgroups of new and existing enrollees. An interrupted time series model was estimated to examine time trends and impact of the COVID-19 pandemic onset on trends.
Between 2017 and 2022, the proportion of enrollees receiving consumer-directed care increased from 10.3% to 47.9%. Sociodemographic characteristics and average personal care hours remained stable. Models identified a 6% yearly increase in the proportion of enrollees using consumer-directed care pre-pandemic, (P < .001) an immediate 4% bump in use in March 2020 at the onset of the COVID-19 pandemic (P = .001), and an 8% yearly increase in use post pandemic onset (P = .01). Although trends among existing enrollees mirrored overall trends, new enrollees had larger increases in consumer-directed care use early in the study period, which leveled off after March 2020.
While there was a statistically significant and sustained increase in the proportion of enrollees receiving consumer-directed care at onset of the COVID-19 pandemic, the magnitude of this increase was small in comparison with overall program growth between 2017 and 2022. Additional work to understand how other factors contribute to enrollees choosing consumer-directed care is needed to ensure all Medicaid-funded personal care recipients can have their needs met in the community.
尽管对扩大医疗补助计划资助的个人护理的消费者导向（或自我导向）模式的兴趣日益浓厚，但对该计划使用情况进行特征描述的研究却很有限。我们利用纽约一家大型健康计划的健康计划和理赔数据，来研究（1）消费者导向护理的使用趋势，以及（2）2019冠状病毒病大流行对消费者导向护理使用的影响。
回顾性队列研究。
2017年1月至2022年12月期间，纽约一家大型健康计划中所有参加医疗补助计划资助的个人护理的参保人（n = 47216）。
计算所有参保人以及新参保人和现有参保人亚组在每个月和每年接受消费者导向护理的参保人的比例。估计一个中断时间序列模型，以研究时间趋势以及2019冠状病毒病大流行开始对趋势的影响。
2017年至2022年期间，接受消费者导向护理的参保人的比例从10.3%增至47.9%。社会人口统计学特征和平均个人护理时长保持稳定。模型显示，在大流行前，使用消费者导向护理的参保人的比例每年增长6%（P < 0.001），在2020年3月2019冠状病毒病大流行开始时，使用率立即跃升4%（P = 0.001），在大流行开始后，使用率每年增长8%（P = 0.01）。尽管现有参保人的趋势反映了总体趋势，但新参保人在研究初期消费者导向护理的使用增长幅度更大，在2020年3月后趋于平稳。
虽然在2019冠状病毒病大流行开始时，接受消费者导向护理的参保人的比例在统计学上有显著且持续的增长，但与2017年至2022年期间该计划的总体增长相比，这一增长幅度较小。需要开展更多工作来了解其他因素如何促使参保人选择消费者导向护理，以确保所有医疗补助计划资助的个人护理接受者的需求在社区中得到满足。
