Factors Associated With Hospitalization by Veterans in Home-Based Primary Care
Published by Elsevier Inc..
OBJECTIVES: This study examined the extent to which program site-based and Veteran characteristics were associated with potentially avoidable hospitalizations or other hospitalization of Veterans enrolled in the Veterans Affairs (VA) Home-Based Primary Care (HBPC).
DESIGN: Retrospective claims-based study.
SETTING AND PARTICIPANTS: HBPC programs that responded to a national survey of HBPC programs (n = 189) in fiscal year (FY) 2016 were studied. Veterans in the analysis cohort were identified as having been enrolled in VA-HBPC in FY2016 who had not received care by VA-HBPC within 1 year prior to their first HBPC enrollment in FY2016 (N = 8497).
METHODS: Multinomial logistic regression analysis with 5 outcome categories within the 6 months following the first HBPC enrollment date: (1) any potentially avoidable hospitalizations for ambulatory care-sensitive conditions (ACSC) as identified by AHRQ Prevention Quality Indicator (PQI), (2) any other hospitalizations for non-ACSC conditions, (3) died during study period, (4) discharged from HBPC, or (5) remained at home with HBPC. Average marginal effects (AME) of veteran-level and VA-HBPC-level covariates are reported for each of the outcome categories.
RESULTS: More frail Veterans and Veterans 85 years old or older were more likely to have potentially preventable ACSC hospitalizations (AME = 5.4%, 1.8%, respectively). Veterans who were younger than 75 years, functionally impaired, bed-bound, or frail were more likely to have non-ACSC hospitalization (AME = 3.0%, 2.2%, 3.5%, and 9.0%, respectively). Veterans with low frailty index scores were less likely to have non-ACSC hospitalizations (AME = -17.1%). Six-month hospitalization patterns were not associated with reported HBPC site characteristics.
CONCLUSIONS AND IMPLICATIONS: Within the framework of the national VA HBPC program, variations in the structural model used at HBPC sites are not significantly associated with hospitalizations. Tailoring of HBPC care, based on individual patient factors and clinical judgment rather than standard protocols, may be central to the success of HBPC in reducing ACSC hospitalizations.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
|---|---|
| Enthalten in: |
Journal of the American Medical Directors Association - 22(2021), 5 vom: 20. Mai, Seite 1043-1051.e1 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Gillespie, Suzanne M [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Home-Based Primary Care |
|---|
| Anmerkungen: |
Date Completed 01.07.2021 Date Revised 01.07.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jamda.2020.12.033 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM320854485 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM320854485 | ||
| 003 | DE-627 | ||
| 005 | 20231225174534.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jamda.2020.12.033 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1069.xml |
| 035 | |a (DE-627)NLM320854485 | ||
| 035 | |a (NLM)33524340 | ||
| 035 | |a (PII)S1525-8610(20)31100-2 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Gillespie, Suzanne M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Factors Associated With Hospitalization by Veterans in Home-Based Primary Care |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 01.07.2021 | ||
| 500 | |a Date Revised 01.07.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published by Elsevier Inc. | ||
| 520 | |a OBJECTIVES: This study examined the extent to which program site-based and Veteran characteristics were associated with potentially avoidable hospitalizations or other hospitalization of Veterans enrolled in the Veterans Affairs (VA) Home-Based Primary Care (HBPC) | ||
| 520 | |a DESIGN: Retrospective claims-based study | ||
| 520 | |a SETTING AND PARTICIPANTS: HBPC programs that responded to a national survey of HBPC programs (n = 189) in fiscal year (FY) 2016 were studied. Veterans in the analysis cohort were identified as having been enrolled in VA-HBPC in FY2016 who had not received care by VA-HBPC within 1 year prior to their first HBPC enrollment in FY2016 (N = 8497) | ||
| 520 | |a METHODS: Multinomial logistic regression analysis with 5 outcome categories within the 6 months following the first HBPC enrollment date: (1) any potentially avoidable hospitalizations for ambulatory care-sensitive conditions (ACSC) as identified by AHRQ Prevention Quality Indicator (PQI), (2) any other hospitalizations for non-ACSC conditions, (3) died during study period, (4) discharged from HBPC, or (5) remained at home with HBPC. Average marginal effects (AME) of veteran-level and VA-HBPC-level covariates are reported for each of the outcome categories | ||
| 520 | |a RESULTS: More frail Veterans and Veterans 85 years old or older were more likely to have potentially preventable ACSC hospitalizations (AME = 5.4%, 1.8%, respectively). Veterans who were younger than 75 years, functionally impaired, bed-bound, or frail were more likely to have non-ACSC hospitalization (AME = 3.0%, 2.2%, 3.5%, and 9.0%, respectively). Veterans with low frailty index scores were less likely to have non-ACSC hospitalizations (AME = -17.1%). Six-month hospitalization patterns were not associated with reported HBPC site characteristics | ||
| 520 | |a CONCLUSIONS AND IMPLICATIONS: Within the framework of the national VA HBPC program, variations in the structural model used at HBPC sites are not significantly associated with hospitalizations. Tailoring of HBPC care, based on individual patient factors and clinical judgment rather than standard protocols, may be central to the success of HBPC in reducing ACSC hospitalizations | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, U.S. Gov't, Non-P.H.S. | |
| 650 | 4 | |a Home-Based Primary Care | |
| 650 | 4 | |a Veterans | |
| 650 | 4 | |a hospitalization | |
| 700 | 1 | |a Li, Jiejin |e verfasserin |4 aut | |
| 700 | 1 | |a Karuza, Jurgis |e verfasserin |4 aut | |
| 700 | 1 | |a Levy, Cari |e verfasserin |4 aut | |
| 700 | 1 | |a Dang, Stuti |e verfasserin |4 aut | |
| 700 | 1 | |a Olsan, Tobie |e verfasserin |4 aut | |
| 700 | 1 | |a Kinosian, Bruce |e verfasserin |4 aut | |
| 700 | 1 | |a Intrator, Orna |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of the American Medical Directors Association |d 2000 |g 22(2021), 5 vom: 20. Mai, Seite 1043-1051.e1 |w (DE-627)NLM125714041 |x 1538-9375 |7 nnns |
| 773 | 1 | 8 | |g volume:22 |g year:2021 |g number:5 |g day:20 |g month:05 |g pages:1043-1051.e1 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jamda.2020.12.033 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 22 |j 2021 |e 5 |b 20 |c 05 |h 1043-1051.e1 | ||