Epidemiology of Homebound Population Among Beneficiaries of a Large National Medicare Advantage Plan.

IF 19.6 1区医学 Q1 MEDICINE, GENERAL & INTERNAL Annals of Internal Medicine Pub Date : 2024-08-13 DOI:10.7326/M24-0011

Bruce Leff, Christine Ritchie, Sarah Szanton, Oren Shapira, Amanda Sutherland, Andrew Lynch, Brian W Powers, Mona Siddiqui, Katherine A Ornstein

{"title":"Epidemiology of Homebound Population Among Beneficiaries of a Large National Medicare Advantage Plan.","authors":"Bruce Leff, Christine Ritchie, Sarah Szanton, Oren Shapira, Amanda Sutherland, Andrew Lynch, Brian W Powers, Mona Siddiqui, Katherine A Ornstein","doi":"10.7326/M24-0011","DOIUrl":null,"url":null,"abstract":"Background: Interest in home-based care is increasing among Medicare Advantage (MA) plans. The epidemiology of homebound MA beneficiaries is unknown.Objective: To determine the prevalence, characteristics, predictors, health service use, and mortality outcomes of homebound beneficiaries of a large national MA plan.Design: Cross-sectional.Setting: National MA plan.Participants: Humana MA beneficiaries in 2022 (n = 2 435 519).Measurements: Homebound status was assessed via in-home assessment using previously defined categories: homebound (never or rarely left home in the past month), semihomebound (left home with assistance, had difficulty, or needed help leaving home), and not homebound. Demographic, clinical, health service use, and mortality outcomes were compared by homebound status.Results: In 2022, the overall prevalence of homebound beneficiaries was 22.0% (8.4% of beneficiaries were homebound, and 13.6% were semihomebound). In adjusted models, female sex (odds ratio [OR], 1.36 [95% CI, 1.35 to 1.37), low-income status or dual eligibility for Medicare and Medicaid (OR, 1.56 [CI, 1.55 to 1.57]), dementia (OR, 2.36 [CI, 2.33 to 2.39]), and moderate to severe frailty (OR, 4.32 [CI, 4.19 to 4.45]) were predictive of homebound status. In multivariable logistic regression, homebound status was associated with increased odds of any emergency department visit (OR, 1.14 [ CI, 1.14 to 1.15]), any inpatient hospital admission (OR, 1.44 [CI, 1.42 to 1.46]), any skilled-nursing facility admission (OR, 2.18 [CI, 2.13 to 2.23]), and death (OR, 2.55 [CI, 2.52 to 2.58]).Limitation: The study period overlapped the tail end of the COVID-19 pandemic, and data were derived from a single national MA plan, which limits generalizability.Conclusion: Overall homebound prevalence in a national MA plan was 22.0% and was independently associated with increased health service use and mortality. Study findings can inform strategic initiatives to identify and manage care for homebound beneficiaries.Primary funding source: Humana, under a collaborative research agreement with Johns Hopkins University.","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6000,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7326/M24-0011","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Interest in home-based care is increasing among Medicare Advantage (MA) plans. The epidemiology of homebound MA beneficiaries is unknown.

Objective: To determine the prevalence, characteristics, predictors, health service use, and mortality outcomes of homebound beneficiaries of a large national MA plan.

Design: Cross-sectional.

Setting: National MA plan.

Participants: Humana MA beneficiaries in 2022 (n = 2 435 519).

Measurements: Homebound status was assessed via in-home assessment using previously defined categories: homebound (never or rarely left home in the past month), semihomebound (left home with assistance, had difficulty, or needed help leaving home), and not homebound. Demographic, clinical, health service use, and mortality outcomes were compared by homebound status.

Results: In 2022, the overall prevalence of homebound beneficiaries was 22.0% (8.4% of beneficiaries were homebound, and 13.6% were semihomebound). In adjusted models, female sex (odds ratio [OR], 1.36 [95% CI, 1.35 to 1.37), low-income status or dual eligibility for Medicare and Medicaid (OR, 1.56 [CI, 1.55 to 1.57]), dementia (OR, 2.36 [CI, 2.33 to 2.39]), and moderate to severe frailty (OR, 4.32 [CI, 4.19 to 4.45]) were predictive of homebound status. In multivariable logistic regression, homebound status was associated with increased odds of any emergency department visit (OR, 1.14 [ CI, 1.14 to 1.15]), any inpatient hospital admission (OR, 1.44 [CI, 1.42 to 1.46]), any skilled-nursing facility admission (OR, 2.18 [CI, 2.13 to 2.23]), and death (OR, 2.55 [CI, 2.52 to 2.58]).

Limitation: The study period overlapped the tail end of the COVID-19 pandemic, and data were derived from a single national MA plan, which limits generalizability.

Conclusion: Overall homebound prevalence in a national MA plan was 22.0% and was independently associated with increased health service use and mortality. Study findings can inform strategic initiatives to identify and manage care for homebound beneficiaries.

Primary funding source: Humana, under a collaborative research agreement with Johns Hopkins University.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

大型全国性医疗保险优势计划受益人中居家人群的流行病学。

背景：医疗保险优势计划（MA）对居家护理的兴趣与日俱增。居家医疗保险受益人的流行病学尚不清楚：目的：确定一个大型全国性医疗保险计划中居家护理受益人的患病率、特征、预测因素、医疗服务使用情况和死亡结果：设计：横断面：参与者：20 年内的 Humana MA 受益人2022 年的 Humana MA 受益人（n = 2 435 519）：居家状态通过居家评估进行评估，使用之前定义的类别：居家（过去一个月从未或很少离开家）、半居家（离开家时需要帮助、有困难或需要帮助）和不居家。根据居家状态对人口统计学、临床、医疗服务使用和死亡率结果进行了比较：2022 年，居家护理受益人的总体患病率为 22.0%（8.4% 的受益人居家护理，13.6% 的受益人半居家护理）。在调整后的模型中，女性（几率比 [OR]，1.36 [95% CI，1.35 至 1.37]）、低收入状况或医疗保险和医疗补助双重资格（OR，1.56 [CI，1.55 至 1.57]）、痴呆（OR，2.36 [CI，2.33 至 2.39]）和中度至重度虚弱（OR，4.32 [CI，4.19 至 4.45]）是居家状态的预测因素。在多变量逻辑回归中，居家状态与急诊就诊（OR，1.14 [ CI，1.14 至 1.15]）、住院（OR，1.44 [CI，1.42 至 1.46]）、入住专业护理机构（OR，2.18 [CI，2.13 至 2.23]）和死亡（OR，2.55 [CI，2.52 至 2.58]）的几率增加有关：研究时间与 COVID-19 大流行的尾声重叠，数据来自单一的国家医疗保健计划，这限制了数据的普遍性：结论：在一项国家医疗保险计划中，居家护理的总体流行率为 22.0%，且与医疗服务使用率和死亡率的增加有独立关联。研究结果可为确定和管理居家受益人护理的战略举措提供参考：主要资金来源：Humana，根据与约翰霍普金斯大学的合作研究协议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.