Jinjiao Wang1, Thomas V Caprio2, Adam Simning3, Jingjing Shang4, Yeates Conwell3, Fang Yu5, Yue Li6. 1. School of Nursing, University of Rochester, Rochester, NY. Electronic address: Jinjiao_wang@urmc.rochester.edu. 2. Department of Medicine, University of Rochester Medical Center, Rochester, NY; University of Rochester Medical Home Care, Rochester, NY; Finger Lakes Geriatric Education Center, NY. 3. Department of Psychiatry, University of Rochester Medical Center, Rochester, NY. 4. School of Nursing, Columbia University, New York, NY. 5. School of Nursing, University of Minnesota, Minneapolis, MN. 6. Department of Public Health Sciences, University of Rochester, Rochester, NY.
Abstract
OBJECTIVES: To evaluate the association between home health (HH) services, including skilled nursing (SN), physical therapy (PT), occupational therapy, social work (SW), and homemaking aide assistance with the hazard of unplanned facility admissions among Medicare patients with and without Alzheimer's disease and related dementias (ADRD). DESIGN: Analysis of the Outcome and Assessment Information Set and billing records. SETTING: A not-for-profit HH agency serving multiple counties in New York State. PARTICIPANTS: Adults ≥65 years old who received HH from January 1, 2017 to December 31, 2017. MEASURES: Outcome was time from HH start of care to an unplanned facility admission of any type, including the hospital, nursing home, and rehabilitation facility. Independent variables included weekly intensity (visits/week, hours/week) of SN, PT, occupational therapy, SW, and, homemaking aide assistance separately. ADRD was identified by diagnosis (International Classification of Diseases, Tenth Revision codes in billing records) and cognitive impairment assessment (Outcome and Assessment Information Set). RESULTS: Of the sample (N = 6153), 14.9% had an unplanned facility admission. In multivariable Cox proportional hazard models that adjusted for time-varying effects of HH intensity and covariates, receiving the highest intensity of SN (3.3 visits of 2.78 hours per week) and PT (2.5 visits of 2 hours per week) was related to up to a 54% and 86% decrease, respectively, in the hazard of unplanned facility admission among patients with ADRD (n = 1525), and decreases of 56% and 90%, respectively, among patients without ADRD (n = 4628). Receiving any SW was related to 40% decreased in the hazard of facility admission in patients without ADRD only. Other HH services were not consistently related to the risk of facility admission. CONCLUSIONS AND IMPLICATIONS: Receiving a higher intensity of SN and PT was associated with reduced hazards of unplanned facility admission among HH patients with and without ADRD. Policies should ensure that patients with ADRD receive a sufficient amount and appropriate mix of HH services.
OBJECTIVES: To evaluate the association between home health (HH) services, including skilled nursing (SN), physical therapy (PT), occupational therapy, social work (SW), and homemaking aide assistance with the hazard of unplanned facility admissions among Medicare patients with and without Alzheimer's disease and related dementias (ADRD). DESIGN: Analysis of the Outcome and Assessment Information Set and billing records. SETTING: A not-for-profit HH agency serving multiple counties in New York State. PARTICIPANTS: Adults ≥65 years old who received HH from January 1, 2017 to December 31, 2017. MEASURES: Outcome was time from HH start of care to an unplanned facility admission of any type, including the hospital, nursing home, and rehabilitation facility. Independent variables included weekly intensity (visits/week, hours/week) of SN, PT, occupational therapy, SW, and, homemaking aide assistance separately. ADRD was identified by diagnosis (International Classification of Diseases, Tenth Revision codes in billing records) and cognitive impairment assessment (Outcome and Assessment Information Set). RESULTS: Of the sample (N = 6153), 14.9% had an unplanned facility admission. In multivariable Cox proportional hazard models that adjusted for time-varying effects of HH intensity and covariates, receiving the highest intensity of SN (3.3 visits of 2.78 hours per week) and PT (2.5 visits of 2 hours per week) was related to up to a 54% and 86% decrease, respectively, in the hazard of unplanned facility admission among patients with ADRD (n = 1525), and decreases of 56% and 90%, respectively, among patients without ADRD (n = 4628). Receiving any SW was related to 40% decreased in the hazard of facility admission in patients without ADRD only. Other HH services were not consistently related to the risk of facility admission. CONCLUSIONS AND IMPLICATIONS: Receiving a higher intensity of SN and PT was associated with reduced hazards of unplanned facility admission among HH patients with and without ADRD. Policies should ensure that patients with ADRD receive a sufficient amount and appropriate mix of HH services.
Authors: Jinjiao Wang; Jenny Y Shen; Fang Yu; Yeates Conwell; Kobi Nathan; Avantika S Shah; Sandra F Simmons; Yue Li; Erika Ramsdale; Thomas V Caprio Journal: J Am Med Dir Assoc Date: 2022-04-28 Impact factor: 7.802
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