Effects of Home-Based Primary Care on Medicare Costs in High-Risk Elders

被引:141
作者
De Jonge, K. Eric [1 ]
Jamshed, Namirah [1 ]
Gilden, Daniel [2 ]
Kubisiak, Joanna [2 ]
Bruce, Stephanie R. [1 ]
Taler, George [1 ]
机构
[1] MedStar Washington Hosp Ctr, Sect Geriatr, Washington, DC 20010 USA
[2] JEN Associates, Cambridge, MA USA
关键词
home-based primary care; frail elders; Medicare costs; survival; OLDER-ADULTS; HOUSE CALLS; HEALTH; BURDEN;
D O I
10.1111/jgs.12974
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
ObjectivesTo determine the effect of home-based primary care (HBPC) on Medicare costs and mortality in frail elders. DesignCase-control concurrent study using Medicare administrative data. SettingHBPC practice in Washington, District of Columbia. ParticipantsHBPC cases (n=722) and controls (n=2,161) matched for sex, age bands, race, Medicare buy-in status (whether Medicaid covers Part B premiums), long-term nursing home status, cognitive impairment, and frailty. Cases were eligible if enrolled in MedStar Washington Hospital Center's HBPC program during 2004 to 2008. Controls were selected from Washington, District of Columbia, and urban counties in Virginia, Maryland, and Pennsylvania. InterventionHBPC clinical service. MeasurementsMedicare costs, utilization events, mortality. ResultsMean age was 83.7 for cases and 82.0 for controls (P<.001). A majority of both groups was female (77%) and African American (90%). During a mean 2-year follow-up, in univariate analysis, cases had lower Medicare ($44,455 vs $50,977, P=.01), hospital ($17,805 vs $22,096, P=.003), and skilled nursing facility care ($4,821 vs $6,098, P=.001) costs, and higher home health ($6,579 vs $4,169; P<.001) and hospice ($3,144 vs. $1,505; P=.005) costs. Cases had 23% fewer subspecialist visits (P=.001) and 105% more generalist visits (P<.001). In a multivariate model, cases had 17% lower Medicare costs, averaging $8,477 less per beneficiary (P=.003) over 2years of follow-up. There was no difference between cases and controls in mortality (40% vs 36%, hazard ratio=1.06, P=.44) or in average time to death (16.2 vs 16.8months, P=.30). ConclusionHBPC reduces Medicare costs for ill elders, with similar survival outcomes in cases and controls.
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页码:1825 / 1831
页数:7
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