107P
Cognitive Impairment Linked to Increased Service Use, Readmission Rates, and Costs in Home Health Care
The dramatic aging of the population corresponds with increases in neurocognitive disorders such as Alzheimer’s disease. People with neurocognitive disorder need extraordinary levels of care, suffer from repeated health care crises, and experience medical complications which can lead to elevated costs to health insurance programs such as Medicare and Medicaid. A continuum of health programs provides formal care for older adults and those with disabilities. Home health provides short-term care as well as ongoing support to help people with functional disabilities remain at home after acquiring a disability or chronic illness as well as during brief periods of rehabilitation after hospital procedures. This is the first study documenting profiles of home health service use among patients with neurocognitive disorder. Research question: Is patient cognitive status significantly associated with the number of home health services visits, types of services received, health insurance programs used to pay for services, and costs of care?
Methods:
This study adapts the Anderson-Newman Health Services Utilization Model and uses newly available survey data to make novel comparisons between patients with moderate-to-severe cognitive impairment and those with little-to-no cognitive impairment. The National Home and Hospice Care Survey is a nationally representative cross-sectional sample survey conducted by the U.S. National Center for Health Statistics (NCHS), and this study uses data from the most recent survey (2007) to examine a random sample of 3,309 patients nested within 595 randomly sampled agencies. Data were collected by the NCHS through in-person interviews with agency staffs who used agency records to answer survey questions.
Cognitive status was measured with a 5-point scale from the uniform data collection instrument used in home health. Weighted analyses of multiply-imputed data are examined through bivariate tests of significance and multivariate regressions to test the associations of cognitive status with home health service volume, type and cost while controlling for relevant patient characteristics, including predisposing, enabling and illness-level factors fitting with the guiding theoretical framework.
Results:
Findings vary in magnitude and significance depending on the insurance program used to pay for services. Patients with moderate-to-severe cognitive impairment receive services for 41-210 additional days, including 5-6 additional medical and non-medical visits, and have a 9-67% greater likelihood of readmission, as compared to their less impaired peers. Patients with moderate-to-severe cognitive impairment are shown to require services with overall costs that are 42-208% greater than the costs of services provided to their peers.
Conclusions and Implications:
Home health care patients with moderate-to-severe cognitive impairment receive more service visits over longer episodes of care, with higher average daily costs and greater readmission rates. These findings demonstrate unique profiles of service use for this patient population, and suggest that home health providers and policymakers should examine service and financing models that assure appropriate high-quality care for this vulnerable population while striving for efficient delivery of care. The rapid aging of the population, coupled with the considerable complications associated with dementia care, lends particular urgency to the need for intervention, program development, and policy change in this arena.