期刊
ALZHEIMERS & DEMENTIA
卷 18, 期 6, 页码 1100-1108出版社
WILEY
DOI: 10.1002/alz.12438
关键词
cognitive function; cognitive impairments; home health care; home care agencies; medicare
资金
- National Institute on Aging [T32AG066576, K23AG064036]
- Eugenie and Joseph Doyle Research Partnership Fund of the Visiting Nurse Service of New York
Patients with cognitive impairment in Medicare-funded home health care are more likely to receive multiple successive HHC episodes and additional visits during the initial HHC episode, suggesting that recent reimbursement changes do not consider the more intensive care needs of these patients.
Background In Medicare-funded home health care (HHC), one in three patients has cognitive impairment (CI), but little is known about the care intensity they receive in this setting. Recent HHC reimbursement changes fail to adjust for patient CI, potentially creating a financial disincentive to caring for these individuals. Methods This cohort study included a nationally representative sample of 1214 Medicare HHC patients between 2011 and 2016. Multivariable logistic and negative binomial regressions modelled the relationship between patient CI and care intensity-measured as the number and type of visits received during HHC and likelihood of receiving multiple successive HHC episodes. Results Patients with CI had 45% (P < .05) greater odds of receiving multiple successive HHC episodes and received an additional 2.82 total (P < .001), 1.39 nursing (P = .003), 0.72 physical therapy (P = .03), and 0.60 occupational therapy visits (P = .01) during the index HHC episode. Discussion Recent HHC reimbursement changes do not reflect the more intensive care needs of patients with CI.
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