Effects of home-based primary care on Medicare costs in high-risk elders.

MedStar author(s):
Citation: Journal of the American Geriatrics Society. 62(10):1825-31, 2014 Oct.PMID: 25039690Institution: MedStar Washington Hospital CenterDepartment: Medicine/GeriatricsForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Frail Elderly | *Home Care Services/ec [Economics] | *Medicare/ec [Economics] | *Primary Health Care/ec [Economics] | Aged | Aged, 80 and over | Case-Control Studies | Female | Follow-Up Studies | Humans | Male | Mortality | Multivariate Analysis | United States | Urban Health Services/ec [Economics]Local holdings: Available online from MWHC library: 1995 - 2000, then 2006-present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-8614
Name of journal: Journal of the American Geriatrics SocietyAbstract: CONCLUSION: HBPC reduces Medicare costs for ill elders, with similar survival outcomes in cases and controls.Copyright � 2014 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.DESIGN: Case-control concurrent study using Medicare administrative data.INTERVENTION: HBPC clinical service.MEASUREMENTS: Medicare costs, utilization events, mortality.OBJECTIVES: To determine the effect of home-based primary care (HBPC) on Medicare costs and mortality in frail elders.PARTICIPANTS: HBPC 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.RESULTS: Mean 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 (SETTING: HBPC practice in Washington, District of Columbia.All authors: Bruce SR, De Jonge KE, Gilden D, Jamshed N, Kubisiak J, Taler GDigital Object Identifier: Date added to catalog: 2015-03-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 25039690

Available online from MWHC library: 1995 - 2000, then 2006-present, Available in print through MWHC library: 1999 - 2006

CONCLUSION: HBPC reduces Medicare costs for ill elders, with similar survival outcomes in cases and controls.Copyright � 2014 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

DESIGN: Case-control concurrent study using Medicare administrative data.

INTERVENTION: HBPC clinical service.

MEASUREMENTS: Medicare costs, utilization events, mortality.

OBJECTIVES: To determine the effect of home-based primary care (HBPC) on Medicare costs and mortality in frail elders.

PARTICIPANTS: HBPC 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.

RESULTS: Mean 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 ( 4, 455 vs 0, 977, P = .01), hospital ( 7, 805 vs 2, 096, P = .003), and skilled nursing facility care ( , 821 vs , 098, P = .001) costs, and higher home health ( , 579 vs , 169; P < .001) and hospice ( , 144 vs. , 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 , 477 less per beneficiary (P = .003) over 2 years 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 16.8 months, P = .30).

SETTING: HBPC practice in Washington, District of Columbia.

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