Home‐Based Primary and Palliative Care in the Medicaid Program: Systematic Review of the Literature

Zimbroff, Robert M.; Ritchie, Christine S.; Leff, Bruce; Sheehan, Orla C.

doi:10.1111/jgs.16837

Cited by 14 publications

(9 citation statements)

References 23 publications

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“…Doing so will be vital for addressing pressures on health services resulting from population ageing, the COVID-19 pandemic and fiscal austerity. Currently, this comparative evidence remains very limited [ 4 , 34 , 39 , 40 ]. Our findings contribute to that evidence base, with reference to a specific set of effects for a single intervention.…”

Section: Discussionmentioning

confidence: 99%

The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people

Lloyd‐Sherlock

Giacomin

Sempé

2022

BMC Health Serv Res

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Background Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC – Older Person’s Care Program). This paper examines two potential associations between inclusion in PMC on types of outpatient health service utilization by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits. Methods We apply a quasi-experimental design to a unique set of health administrative data recording visits to outpatient health services. We focus on comparisons of the universe of visits, transformed to ratios of planned/unplanned visits and rehabilitation/other reasons for visiting the outpatient service. First, we preprocess our sample through different matching techniques such as ‘coarsened exact matching’ (CEM), ‘nearest neighbor’ based on logit scores (NN), ‘optimal pair’ (OP) and ‘optimal full’ (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use Poisson regressions controlling for individual and community factors and use robust standard errors. Our results are presented as the comparative incidence ratio of PMC on rehabilitation and planned visits. Results We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. Poisson models using CEM shows a higher incidence rate for planned visits in comparison to unplanned visits, 1.3 (95% CI 1.1–1.4), by PMC patients compared to the non-PMC controls, and a higher proportion of visits for rehabilitation, 3.4 (95% CI 1.7–6.8). Similar positive results are found across other matching methods and models. Conclusions Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls for a greater ratio of making outpatient visits that were planned, rather than unplanned. We find similar associations for the proportion of visits made for rehabilitation, as opposed to other reasons. These findings indicate that PMC influences some elements of outpatient health service utilization by dependent older people.

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Section: Discussionmentioning

confidence: 99%

The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people

Lloyd‐Sherlock

Giacomin

Sempé

2022

BMC Health Serv Res

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“…Firstly, the majority of studies evaluating the effect of HHC had short follow-up periods, often less than 12 months after the HHC started. [49][50][51] Data about end-of-life outcomes that occurred within the nal year before death were neither investigated nor analyzed separately, leading to fewer papers meeting our selection criteria. 51,52 Secondly, none of the included studies were rated as high quality in critical appraisal.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Impact of Home Healthcare on End-of-life Outcomes for People With Dementia: a Systematic Review

Chen¹,

Smits²,

Miranda³

et al. 2021

Preprint

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Background: Home healthcare (HHC) may reduce acute hospital utilization, but its effect on homebound people living with dementia (PLWD) at end-of-life remains unclear. We aim to describe the impact of HHC on acute healthcare utilization and end-of-life outcomes in PLWD.Methods: Design: A systematic review of quantitative and qualitative studies regarding the association between HHC (exposure) and targeted outcomes. Interventions: HHC provided by health care professionals, including physicians or nurses. Participants: At least 80% of study participants had dementia and lived at home. Measurements: Primary outcome was acute healthcare utilization in the last year of life. Secondary outcomes included palliative care use, advance care planning (ACP), continuity of care in the last year of life, and place of death. We identified contextual information about policy changes in HHC for these outcomes.Results: We included five studies from USA, Japan, and Italy, none of which received a high-quality rating. At micro-level, HHC may be associated with a lower risk of acute healthcare utilization in the early period (e.g., last 90 days before death) and a higher risk in the late period (e.g. last 15 days) of the disease trajectory toward end-of-life in PLWD. ACP with written decisions may be an important mediator of this. HHC increases referrals to palliative care. At meso-level, HHC providers’ difficulty in making treatment decisions for PLWD at the end-of-life may require further training and external support. Coordination between HHC and social care is mentioned but not well examined in the existing literature.Conclusions: The review highlights the dearth of dementia-specific research regarding the impact of HHC on end-of-life outcomes. In PLWD, the core components of HHC for achieving better quality end-of-life, the integration between health and social care, and coordination between primary HHC and palliative care should be further investigated in future studies.

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“…В качестве наиболее перспективного направления можно рассматривать домашние стационары после перенесенных операций, при наличии хронической сердечной недостаточности (ХСН), нейро дегенеративных заболеваний, заболеваний органов дыхания, для оказания паллиативной помощи и др. [8][9][10].…”

Section: медицинский телепатронаж как здоровьесберегающая технология при ведении больных с хроническими неинфекционными заболеваниямиunclassified

Medical telepatronage as a health-saving technology in the management of patients with chronic non-communicable diseases

Горенков¹,

Iwanitsky²,

Pozharov³

et al. 2021

CPT

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he article reviews the definition of medical telepatronage, its tasks, functions, efficiency and perspectives of implementation into the clinical practice. The main goals of telepatronage are therapeutic and preventive measures based on the remote interaction of health care practioner with a patient. Telepatronage includes remote observation of the patient, self-monitoring of the disease and prescrtiptions, patient motivation and education on the digital Web 2.0 platform, and the creation of a remote coordination center. The authors present their own experience in remote monitoring of patients with rheumatic diseases, which is planned to be expanded to create a medical telepatronage system.

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Home‐Based Primary and Palliative Care in the Medicaid Program: Systematic Review of the Literature

Cited by 14 publications

References 23 publications

The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people

The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people

Impact of Home Healthcare on End-of-life Outcomes for People With Dementia: a Systematic Review

Medical telepatronage as a health-saving technology in the management of patients with chronic non-communicable diseases

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