Evidence map›Paper›PMID 37931897›Full record

ArticleJournal of the American Medical Directors Association2024

Drivers of Community-Entry Home Health Care Utilization Among Older Adults.

Julia G Burgdorf, Christine S Ritchie, Jennifer M Reckrey, Bian Liu, Catherine McDonough, Katherine A Ornstein

Abstract read
In one paragraph

Article in Journal of the American Medical Directors Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
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  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Julia G BurgdorfCenter for Home Care Policy & Research, VNS Health, New York, NY, USA.
Christine S RitchieMongan Institute Center for Aging and Serious Illness, Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Jennifer M ReckreyDepartment of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Bian LiuDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Catherine McDonoughDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Katherine A OrnsteinCenter for Equity in Aging, Johns Hopkins School of Nursing, Baltimore, MD, USA. Electronic address: ornstein@jhu.edu.

Funding

Unnecessary and Harmful Medication Use in Older Adults with DementiaP01AG066605 · NIA · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI R. Sean Morrison · 2020 to 2026
$17.7M
Home, but homebound: The impact of caregiving, financial, and community resources on the lives of individuals with dementiaR01AG060967 · NIA · JOHNS HOPKINS UNIVERSITY · PI ORNSTEIN, KATHERINE A · 2019 to 2023
$2.5M
Supporting Dementia Caregivers During Medicare Home Health: Developing the DECLARE Needs Assessment InterventionK01AG081502 · NIA · VISITING NURSE SERVICE OF NEW YORK · PI Julia Burgdorf · 2023 to 2026
$534k
NIA NIH HHS K01 AG081502NIA NIH HHS P01 AG066605NIA NIH HHS R01 AG060967
6 · The paper itself

Abstract

objectivesA growing proportion of Medicare home health (HH) patients are "community-entry," meaning referred to HH without a preceding hospitalization. We sought to identify factors that predict community-entry HH use among older adults to provide foundational information regarding care needs and circumstances that may prompt community-entry HH referral.

designNationally representative cohort study. SETTING AND

participantsHealth and Retirement Study (HRS) respondents who were aged ≥65 years, community-living, and enrolled in Medicare between 2012 and 2018 (n = 11,425 unique individuals providing 27,026 two-year observation periods).

methodsHRS data were linked with standardized HH patient assessments. Community-entry HH utilization was defined as incurring one or more HH episode with no preceding hospitalization or institutional post-acute care stay (determined via assessment item indicating institutional care within 14 days of HH admission) within 2 years of HRS interview. Weighted, multivariable logistic regression was used to model community-entry HH use as a function of individual, social support, and community characteristics.

resultsThe overall rate of community-entry HH utilization across observation periods was 13.4%. Older adults had higher odds of community-entry HH use if they were Medicaid enrolled [adjusted odds ratio (aOR) = 1.49, P = .001], had fair or poor overall health (aOR = 1.48, P < .001), 3+ activities of daily living limitations (aOR = 1.47, P = .007), and had fallen in the past 2 years (aOR = 1.43, P < .001). Compared with those receiving no caregiver help, individuals were more likely to use community-entry HH if they received family or unpaid help only (aOR = 1.81, P < .001), both family and paid help (aOR = 2.79, P < .001), or paid help only (aOR: 3.46, P < .001). CONCLUSIONS AND IMPLICATIONS: Findings indicate that community-entry HH serves a population with long-term care needs and coexisting clinical complexity, making this an important setting to provide skilled care and prevent avoidable health care utilization. Results highlight the need for ongoing monitoring of community-entry HH accessibility as this service is a key component of home-based care for a high-need subpopulation.

Indexed as

Home Care ServicesMedicareActivities of Daily LivingAgedCohort StudiesHumansPatient Acceptance of Health CareUnited Statescommunity health carehome carehome care agencieshome health careMedicare

Identifiers

PMID37931897
PMCPMC10990820

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.