Home Health Care Utilization in Children With Medicaid

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Sarah A. Sobotka ◽  
David E. Hall ◽  
Cary Thurm ◽  
James Gay ◽  
Jay G. Berry
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Home Health ◽  
Care Utilization ◽  
Coding System ◽  
Nursing Assistant ◽  
Children With Medical Complexity ◽  
Technology Assistance

BACKGROUND: Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments. METHODS: We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in the 2016 IBM Watson MarketScan Medicaid Database. HHC utilizers had ≥ 1 HHC claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes were reviewed to codify provider types when possible: registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA), certified nursing assistant (CNA), or companion/personal attendant. Enrollee clinical characteristics, HHC provider type, and payments were assessed. Chronic conditions were evaluated with Agency for Healthcare Research and Quality’s Chronic Condition Indicators and Feudtner’s Complex Chronic Conditions. RESULTS: Of the 0.8% of children who used HHC, 43.8% were age <1 year, 25% had no chronic condition, 38.6% had a noncomplex chronic condition, 21.5% had a complex chronic condition without technology assistance, and 15.5% had technology assistance (eg, tracheostomy). HHC for children with technology assistance accounted for 72.6% of all HHC spending. Forty-five percent of HHC utilizers received RN/LPN-level care, 7.9% companion/personal attendant care, 5.9% HHA/CNA-level care, and 36% received care from an unspecified provider. For children with technology assistance, the majority (77.2%) received RN/LPN care, 17.5% companion/personal assistant care, and 13.8% HHA/CNA care. CONCLUSIONS: Children using HHC are a heterogeneous population who receive it from a variety of providers. Future investigations should explore the role of nonnurse caregivers, particularly with CMC.

scholarly journals Description, Health Care Utilization, and Outcomes for Home Health Care (HHC) COVID-19 Patients Early in the Pandemic: A Comparison to the General HHC Population

2021 ◽  
pp. 108482232110013
Author(s):  
Tami M. Videon ◽  
Robert J. Rosati ◽  
Steven H. Landers
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Home Health Care ◽  
Private Insurance ◽  
Health Agency ◽  
Home Health ◽  
Care Utilization ◽  
Observational Cohort ◽  
Racial Ethnic ◽  
Retrospective Observational Cohort Study

COVID-19 patients represent a new and distinct population in home health care. Little is known about health care utilization and incremental improvements in health for recovering COVID-19 patients after admission to home health care. Using a retrospective observational cohort study of 5452 episodes of home health care admitted to a New Jersey Home Health Agency between March 15 and May 31, 2020, this study describes COVID-19 Home Health Care (HHC) patients ( n = 842) and compare them to the general HHC population ( n = 4610). COVID HHC patients differ in significant ways from the typical HHC population. COVID patients were more likely to be 65 years of age and younger (41% vs 26%), be from a racial/ethnic minority (60% vs 31%), live with another person (85% vs 76%), have private insurance (28% vs 16%), and began HHC with greater independence in activities-of-daily-living (ADL/IADLs). COVID patients received fewer overall visits than their non-COVID counterparts (11.7 vs 16.3), although they had significantly more remote visits (1.7 vs 0.3). Multivariate analyses show that COVID patients early in the pandemic were 34% (CI, 28%-40%) less likely to be hospitalized and demonstrated significantly greater improvement in all the outcome measures examined compared to the general home health population.

scholarly journals Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions

2019 ◽  
Vol 38 (6) ◽  
pp. 987-993 ◽  
Author(s):  
Carolyn C. Foster ◽  
Rishi K. Agrawal ◽  
Matthew M. Davis
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Home Health ◽  
Children With Medical Complexity ◽  
Future Directions ◽  
Medical Complexity

scholarly journals Impact of Family Caregiver Training on Hospitalization During Medicare Home Health Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 252-253
Author(s):  
Julia Burgdorf ◽  
Jennifer Wolff
Keyword(s):  
Health Care ◽  
Family Caregivers ◽  
Acute Care ◽  
Home Health Care ◽  
Family Caregiver ◽  
Unmet Need ◽  
Home Health ◽  
Care Utilization ◽  
Caregiver Training ◽  
Acute Care Utilization

Abstract Medicare home health providers are required to offer family caregiver training; however, there is little information regarding the impact of family caregiver training on patient outcomes in home health or other care delivery settings. A better understanding of this relationship is necessary to guide development of caregiver training interventions and inform policy discussions surrounding family caregiver training access. This research assesses whether and how unmet need for family caregiver training is associated with acute care utilization during Medicare home health. We examine 1,217 (weighted n=5,870,905) fee-for-service Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011-2016. We link NHATS data with home health patient assessments and Medicare claims, drawing measures of family caregivers’ need for training from home health clinician reports and determining provision of training from Medicare claims. Using weighted, multivariable logistic regressions, we model the marginal change in probability of acute care utilization during home health as a function of family caregivers’ unmet need for training. We found that older adults whose family caregivers had an unmet need for training had a probability of acute care utilization during home health that was 18 percentage points (p=0.001) greater than those whose family caregivers both needed and received training, holding all covariates at their means. Findings support the importance of connecting family caregivers to training resources and suggest one avenue by which investing in caregiver training may be cost-effective for integrated payers and providers.

scholarly journals Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

2008 ◽  
Vol 48 (5) ◽  
pp. 668-678 ◽  
Author(s):  
C. H. Van Houtven ◽  
A. S. Jeffreys ◽  
C. J. Coffman
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Home Health Care ◽  
Home Health ◽  
Care Utilization

scholarly journals Relationships Between Race/Ethnicity and Health Care Utilization Among Older Post-Acute Home Health Care Patients

2018 ◽  
Vol 39 (2) ◽  
pp. 201-213 ◽  
Author(s):  
Jo-Ana D. Chase ◽  
David Russell ◽  
Liming Huang ◽  
Alexandra Hanlon ◽  
Melissa O’Connor ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Ethnic Differences ◽  
Home Health Care ◽  
Service Use ◽  
Home Health ◽  
Care Utilization ◽  
Proactive Management ◽  
Race Ethnicity ◽  
Racial Ethnic

Few studies have explored racial/ethnic differences in health care outcomes among patients receiving home health care (HHC), despite known differences in other care settings. We conducted a retrospective cohort study examining racial/ethnic disparities in rehospitalization and emergency room (ER) use among post-acute patients served by a large northeastern HHC agency between 2013 and 2014 ( N = 22,722). We used multivariable binomial logistic regression to describe the relationship between race/ethnicity and health care utilization outcomes, adjusting for individual-level factors that are conceptually related to health service use. Overall rates of rehospitalization and ER visits were 10% and 13%, respectively. African American and Hispanic patients experienced higher odds of ER visits or rehospitalization during their HHC episode. Racial/ethnic differences in utilization were mediated by enabling factors, such as caregiver availability, and illness-level factors, such as illness severity, functional status, and symptoms. Intervention targets may include early risk assessment, proactive management of clinical conditions, rehabilitative therapy, and caregiver training.

scholarly journals FUNCTIONAL STATUS ASSOCIATED WITH RISK OF READMISSION DURING HOME HEALTH CARE FOR PATIENTS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S823-S823
Author(s):  
Sara Knox ◽  
Brian Downer ◽  
Allen Haas ◽  
Addie Middleton ◽  
Kenneth Ottenbacher
Keyword(s):  
Social Support ◽  
Health Care ◽  
Functional Status ◽  
Home Health Care ◽  
Self Care ◽  
Cognitive Status ◽  
Home Health ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Increased Risk

Abstract Approximately 14.0% of Medicare beneficiaries are readmitted to a hospital within 30-days of home health admission. Individuals with dementia account for 30% of all home health care admissions and are at high-risk for rehospitalizations. Our primary objective was to determine the association between functional status and social support at admission to home health and 30-day potentially preventable readmissions (PPR) during home health care. We conducted a retrospective cohort study of 124,119 Medicare beneficiaries receiving home health (7/2013 – 6/2015) and diagnosed with dementia (ICD-9 codes). Approximately 65% of participants were over the age of 81, 61% were female, and 80% were Caucasian. The primary outcome was 30-day PPR during home health. OASIS items were used to create mobility, self-care, social support, and cognition categories. The overall rate of 30-day PPR was 7.6% (95% CI: 7.4-7.7) but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, the odds ratios (OR) for the most dependent score quartile versus the most independent was 1.68(1.56,1.80 95% CI) for mobility, 1.78 (95% CI: 1.66- 1.91) for self-care, and 1.10(95%CI: 1.03-1.17) for social support. The OR for impaired versus intact cognition was 1.12 (95% CI: 1.05-1.20). Impaired functional and cognitive status as well as limited social support at admission to home health care are associated with increased risk of PPR for individuals with dementia. Future research is needed to determine if strategies targeted at mobility and self-care can decrease PPR during home health for individuals with severe dementia.

Lived Experience of Pediatric Home Health Care Among Families of Children With Medical Complexity

2019 ◽  
Vol 59 (2) ◽  
pp. 178-187 ◽  
Author(s):  
Renee D. Boss ◽  
Jessica C. Raisanen ◽  
Kathryn Detwiler ◽  
Karen Fratantoni ◽  
Susan M. Huff ◽  
...  
Keyword(s):  
Health Care ◽  
Lived Experience ◽  
Home Health Care ◽  
Child Survival ◽  
Well Being ◽  
Home Health ◽  
Central Component ◽  
Medical Conditions ◽  
Children With Medical Complexity ◽  
Care Gaps

Background. For children with complex medical conditions, pediatric home health care is a chronic need. It is a clinical service delivered entirely outside of clinical settings, granting families unparalleled expertise regarding service quality. Methods. Telephone interviews with parents whose children have extensive experiences with home health care. Results: Five themes emerged: (1) benefits of home health care include child survival and family stability; (2) family life is inextricable from home health care schedules, staffing, and services; (3) home health care gaps threaten family physical, mental, and financial well-being; (4) Out-of-pocket costs are common; and (5) families must fight for services as their children’s medical conditions evolve. Conclusions. Families understand better than prescribers, providers, or policy makers what is working, and what is not, with home health care. Family expertise should be the foundation for training other families, clinicians, and home health care agencies, and should be a central component of policy and advocacy in this area.

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