Receipt Of Home-Based Medical Care Among Older Beneficiaries Enrolled In Fee-For-Service Medicare

Reckrey, Jennifer; Yang, Mia; Kinosian, Bruce; Bollens‐Lund, Evan; Leff, Bruce; Ritchie, Christine S.; Ornstein, Katherine

doi:10.1377/hlthaff.2019.01537

Cited by 35 publications

(30 citation statements)

References 24 publications

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“…In particular, home-based primary care may be particularly important for patients with dementia, yet current availability remains low. 29 Consistent with cultural differences regarding family support and use of nursing homes, 30 we find that non-Hispanic White race is associated with a far greater risk of transitions to nursing home status than other racial/ethnic categories combined. Similarly, these findings are consistent with data that shows Black and Hispanic white adults are most likely to be homebound, especially following the onset of COVID-19.…”

Section: Discussionsupporting

confidence: 60%

Prospective assessment of dementia on transitions in homeboundness using multistate Markov models

Ornstein

Liu

Husain

et al. 2021

J American Geriatrics Society

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Background: One in 20 older adults in the United States is homebound and rarely/never leaves home. Although being homebound decreases the quality of the lived experience of individuals with serious illnesses, little is known about the frequency or likelihood of transitions in or out of homebound status. The objective of this study was to characterize the probability of transitions to and from homebound status among older adults and examine the relationship between dementia status and homebound transitions. Methods: Using 2011-2018 data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal study of aging in the United States, we identified 6375 community-dwelling Medicare beneficiaries.Homebound status (independent, semi-homebound (leaving home but with difficulty or help), homebound (rarely or never leaving home), nursing home resident, dead) was assessed annually via self-report. Transition probabilities across states were assessed using a multistate Markov model. Results: Less than half of homebound individuals remain homebound (probability = 41.5% [95% CI: 39.2%, 43.5%]) after 1 year. One out of four dies (24% [22.3%, 26.0%]) and there is a low probability (3.2% [2.5%, 4.1%]) of transition to a nursing home. Dementia status was associated with increased risk of progression from independence to homebound status (HR: 1.83 [1.01, 3.34]). Dementia was consistently associated with increased probabilities of transitions to death including a two-fold increased hazards of progression from homebound to death (HR: 2.18 [1.69, 2.81]). Homebound individuals with dementia have a 34.2% [25.8%, 48.1%] probability of death in 5 years, compared with 17.4% [13.7%, 24.3%] among those without dementia. Discussion: Dementia is associated with greater risk of transitioning across homebound states. There is a greater need to support home-based care for patients with dementia, especially as the ongoing COVID pandemic has raised concerns about the need to invest in alternative models to nursing home care.

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Section: Discussionsupporting

confidence: 60%

Prospective assessment of dementia on transitions in homeboundness using multistate Markov models

Ornstein

Liu

Husain

et al. 2021

J American Geriatrics Society

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“…In the same period, a slow rise in the same indicators for COVID-19 is observed, which then rises steeply after the first reopening at EW 21 up to the implementation of the second control phase in EW 26. In the second control phase (EW [26][27][28][29][30][31], the decrease in hospitalizations for non-COVID-19 causes is smaller than in the first control phase. However, the number of ICU admissions decreased more steeply, and in-hospital deaths increased to values close to the in-hospital mortality of previous years, even in a scenario with significantly less hospitalizations.…”

Section: Resultsmentioning

confidence: 99%

“…While this in fact may be true for the latter, resulting in lower incidences of respiratory communicable diseases, previous studies in Brazil with 45,000 participants have shown that unhealthy behaviours, such as smoking, alcohol use and a sedentary lifestyle, have actually increased during the pandemic [23][24][25]. Furthermore, hospital admissions may decline due to the enhancement of modalities of care that may prevent hospitalization, such as homecare and telemedicine [26,27]. However, the population included in our analysis, who uses public hospitals in Brazil, have negligible access to the cited alternative modalities of care.…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 pandemic course in the number and severity of hospitalizations for other natural causes in a large urban center in Brazil

Brant

Pinheiro

Machado

et al. 2021

PLOS Glob Public Health

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The COVID-19 pandemic may indirectly impact hospitalizations for other natural causes. Belo Horizonte is a city with 2.5 million inhabitants in Brazil, one of the most hardly-hit countries by the pandemic, where local authorities monitored hospitalizations daily to guide regulatory measures. In an ecological, time-series study, we investigated how the pandemic impacted the number and severity of public hospitalizations by other natural causes in the city, during 2020. We assessed the number and proportion of intensive care unit (ICU) admissions and in-hospital deaths for all-natural causes, COVID-19, non-COVID-19 natural causes, and four disease groups: infectious, respiratory, cardiovascular, and neoplasms. Observed data from epidemiological week (EW) 9 (first diagnosis of COVID-19) to EW 48, 2020, was compared to the mean for the same EW of 2015–2019 and differences were tested by Wilcoxon rank-sum test. The five-week moving averages of the studied variables in 2020 were compared to that of 2015–2019 to describe the influence of regulatory measures on the indicators. During the studied period, there was 54,722 hospitalizations by non-COVID-19 natural causes, representing a 28% decline compared to the previous five years (p<0.001). There was a concurrent significant increase in the proportion of ICU admissions and deaths. The greater reductions were simultaneous to the first social distancing decree or occurred in the peak of COVID-19 hospitalizations, suggesting different drivers. Hospitalizations by specific causes decreased significantly, with greater increase in ICU admissions and deaths for infectious, cardiovascular, and respiratory diseases than for neoplasms. While the first reduction may have resulted from avoidance of contact with healthcare facilities, the second reduction may represent competing causes for hospital beds with COVID-19 after reopening of activities. Health policies must include protocols to address hospitalizations by other causes during this or future pandemics, and a plan to face the rebound effect for elective deferred procedures.

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“…29,30 Home-based medical care (HBMC) often serve a disproportionately high number of patients with a diagnosis of dementia. 31 Consistent access to HBMC would alleviate transportation and functional challenges. The transition to virtual visits has the potential to overcome transportation issues, limited geographic options, travel time, and other similar challenges posed by in-person care delivery.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of people with dementia lost to follow‐up from a dementia care center

Boyd

Naasan

Harrison

et al. 2021

Int J Geriat Psychiatry

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Objective: To identify the prevalence and characteristics of people living with dementia (PLWD) lost to follow-up (LTFU) from a specialized dementia care clinic and to understand factors influencing patient follow-up status. Methods:We conducted a retrospective chart review of PLWD seen at a dementia care clinic 2012-2017 who were deceased as of 2018 (n = 746). Participants were evaluated for follow-up status at the time of death. Generalized linear regression was used to analyze demographic and diagnostic characteristics by follow-up status.Text extracted from participant medical records was analyzed using qualitative content analysis to identify reasons patients became LTFU.Results: Among PLWD seen at a dementia care clinic, 42% became LTFU before death, 39% of whom had chart documentation describing reasons for loss to followup. Increased rates of LTFU were associated with female sex (risk ratio 1.27, [95% confidence interval 1.09-1.49]; p = 0.003), educational attainment of high school or less (1.34, [1.13-1.61]; p = 0.001), and death in a long-term care facility (1.46, [1.19-1.80]; p = 0.003). Commonly documented reasons for not returning for care at the clinic included switching care to another provider (42%), logistical difficulty accessing care (26%), patient-family decision to discontinue care (24%), and functional challenges in accessing care (23%).Conclusions: PLWD are LTFU from specialized memory care at high rates. Attention to care coordination, patient-provider communication, and integrated use of alternative care models such as telehealth are potential strategies to improve care. K E Y W O R D Saccess to care, ambulatory, care coordination, continuity of care, dementia, end-of-life, lost to follow-up, memory care, mixed methods, outpatient Key points� Among people living with dementia seen at a specialized memory care center, 42% became lost to follow-up (LTFU) before death.� LTFU rates were higher among women and patients with lower educational attainment.

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Receipt Of Home-Based Medical Care Among Older Beneficiaries Enrolled In Fee-For-Service Medicare

Cited by 35 publications

References 24 publications

Prospective assessment of dementia on transitions in homeboundness using multistate Markov models

Prospective assessment of dementia on transitions in homeboundness using multistate Markov models

The impact of COVID-19 pandemic course in the number and severity of hospitalizations for other natural causes in a large urban center in Brazil

Characteristics of people with dementia lost to follow‐up from a dementia care center

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