Impact of a home health care program for disabled patients in Taiwan

Abstract

The aim of this study was to evaluate the impact of home health care (HHC) for disabled patients. We conducted a nationwide population-based retrospective cohort study. A total of 5838 disabled patients with HHC were identified to match by propensity score with 15,829 disabled patients without HHC receiving tube or catheter care (tracheostomy tube, nasogastric tube, urinary catheter, cystostomy tube, nephrostomy tube) or stage 3 or 4 pressure sore care from the Taiwanese National Health Insurance Research Database between 2005 and 2009. After 1:1 matching, 2901 subjects in the HHC group and 2901 subjects in the non-HHC group were selected and analyzed. Generalized estimating equations (GEEs) were used to compare the risk of health outcomes (rate of hospitalization and emergency services use) and the healthcare expenditure between the 2 groups. Compared to those in the non-HHC group, the patients in the HHC group had significantly higher risk for hospitalization (odds ratio [OR] = 18.43, 95% confidence interval [CI]: 15.62–21.75, P < .001) and emergency services use (OR = 3.72, 95% CI: 3.32–4.17, P < .001) 1 year before the index date. However, 1 year after the index date, the risk for hospitalization (OR = 1.6, 95% CI: 1.41–1.83, P < .001) and emergency services use (OR = 1.16, 95% CI: 1.04–1.30, P < .05) attenuated significantly. Regarding the comparison of total healthcare expenditure 1 year before and after the index date, our study showed an insignificant decrease of US$1.5 per person per day and a significant increase of US$5.2 per person per day ( P < .001) in the HHC and non-HHC groups, respectively. The HHC for disabled patients has a potential role to reduce hospitalization and emergency services use. Besides, the improvement of healthcare quality through HHC was not accompanied by increased healthcare expenditure. The clinical impact of HHC emphasizes the importance for public health officials to promote HHC model to meet the needs of disabled patients.

Medical care needs for patients receiving home healthcare in Taiwan: Do gender and income matter?

“…The present study demonstrates the pattern of medical care needs in HHC in Taiwan at a national level during 1997 and 2013, which is unique compared to previous studies investigated in a shorter period [8][9][10][11][12]. We found that women with income-dependent status had the highest burden of medical care needs in HHC recipients in Taiwan.…”

“…Despite several medical and social elucidations that have been articulated in attempts to account for the differences in medical care needs for HHC, how gender and income influence this association remains unclear, especially for the older population [ 10 , 12 ]. In our study, an increasing proportion of women was noted in the groups with higher medical care needs.…”

“…The demand for long-term care expenditures and total out-of-pocket spending may exacerbate the inequity due to gender and income. Previous studies showed that people receiving HHC are at high risk of acute hospitalization, emergency room visit, and other acute healthcare utilization, especially for those with high medical care needs [ 12 , 43 ]. Our findings suggested an increase in public spending for delivering proper preventive, supportive, and therapeutic care for women with income-dependent status or low-income may be crucial.…”

“…Yet, other research reported that men presented with higher levels of need for HHC since men had higher rates of most chronic conditions, limitations in activities of daily living, and instrumental activities of daily living than women [ 11 ]. Moreover, in the patients who received HHC services, men have higher frequencies of medical care utilization than women among the disabled group [ 12 ] and also were more likely to have multiple hospitalizations in the last 3 months of life than women in people with dementia [ 13 ].…”

The Association between Home Healthcare and Burdensome Transitions at the End-of-Life in People with Dementia: A 12-Year Nationwide Population-Based Cohort Study

“…The slightly higher risk of ET in the HHC group compared to those who did not have HHC may have occurred because people who received HHC may have had more multi-morbidities, more complex care needs, or have been at increased risk of using acute healthcare services before the HHC service [ 30 , 31 ]. For example, disabled people who received HHC in Taiwan had a higher risk of hospitalisation or ER transition after HHC (OR = 1.6, 95 % CI 1.41–1.83 and OR = 1.16, 95 % CI: 1.04–1.30, respectively) compared to the non-HHC group, even though HHC reduced hospital admissions by 80% and ER visits by 65% for people in the HHC group within the year after HHC service [ 30 ]. Another explanation is that better care coordination in home-based services compared with the usual care may identify more cases with unmet needs, leading to an increase in admissions for elderly people [ 32 , 33 ].…”