Preventing Hospitalization with Veterans Affairs Home-Based Primary Care: Which Individuals Benefit Most?
Objectives To examine how medical complexity modifies the relationship between enrollment in Department of Veterans Affairs ( VA) home-based primary care ( HBPC) and hospitalization for ambulatory care-sensitive conditions ( ACSC) for veterans with diabetes mellitus and whether the effect of HBPC on...
| Published in: | Journal of the American Geriatrics Society Vol. 65; no. 8; pp. 1676 - 1684 |
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| Main Authors: | , , , |
| Format: | Article |
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Wiley-Blackwell
Aug2017
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=124623509&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 124623509 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Aug2017 vid: 65 iid: 8 pid: 480 pub: Wiley-Blackwell artinfo: ui: 124623509 10.1111/jgs.14843 ppf: 1676 ppct: 8 formats: tig: atl: Preventing Hospitalization with Veterans Affairs Home-Based Primary Care: Which Individuals Benefit Most? aug: au: Edwards, Samuel T. Saha, Somnath Prentice, Julia C. Pizer, Steven D. affil: Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland Oregon Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland Oregon Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland Oregon Partnered Evidence‐Based Policy Resource Center, Veterans Affairs Boston Healthcare System, Boston Massachusetts School of Medicine, Boston University, Boston Massachusetts School of Public Health, Boston University, Boston Massachusetts Northeastern University, Boston Massachusetts su: United States United States. Dept. of Veterans Affairs Hospital care Home care services Medical care Patient-centered care Chronic diseases Diabetes Veterans Medicare Primary health care Retrospective studies Medical care of veterans Primary care Biocomplexity People with diabetes Medicare beneficiaries Confidence intervals Frail elderly Longitudinal method Regression analysis Odds ratio sug: subj: Hospital care Home care services Medical care Patient-centered care Chronic diseases Diabetes Veterans Medicare Primary health care Retrospective studies United States United States. Dept. of Veterans Affairs Services for the Elderly and Persons with Disabilities Home Health Care Services Offices of All Other Miscellaneous Health Practitioners Offices of all other health practitioners Administration of Human Resource Programs (except Education, Public Health, and Veterans' Affairs Programs) Administration of Veterans' Affairs Medical care of veterans Primary care Biocomplexity People with diabetes Medicare beneficiaries Confidence intervals Frail elderly Longitudinal method Regression analysis Odds ratio keyword: chronic disease frail elderly adults home care services person‐centered care person-centered care policy chronic disease frail elderly adults home care services person‐centered care person-centered care policy ab: Objectives To examine how medical complexity modifies the relationship between enrollment in Department of Veterans Affairs ( VA) home-based primary care ( HBPC) and hospitalization for ambulatory care-sensitive conditions ( ACSC) for veterans with diabetes mellitus and whether the effect of HBPC on hospitalizations varies according to clinical condition. Design Retrospective cohort study. Setting VA and non- VA hospitals. Participants VA beneficiaries aged 67 and older with diabetes mellitus and enrolled in Medicare (N = 364,972). Measurements Instrumental variables regression models were used to estimate the effect of HBPC enrollment on hospitalization for ACSCs (defined according to the Agency for Healthcare Research and Quality Prevention Quality Indicators) overall and in subgroups stratified according to medical complexity. Models were also estimated for each ACSC to determine which conditions were most sensitive to HBPC. Distance from the veteran's residence to the nearest HBPC site was used as the instrumental variable. Results HBPC was associated with fewer ACSC hospitalizations (odds ratio ( OR) = 0.35 per person-month, 95% confidence interval ( CI) = 0.30-0.42). For veterans in the highest quartile of medical complexity, HBPC enrollment was associated with fewer ACSC hospitalizations ( OR = 0.43, 95% CI = 0.19-0.93), whereas for those in the lowest quartile, HBPC was associated with more ACSC hospitalizations ( OR = 33.2, 95% CI = 4.6-240.1). HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs. Conclusion HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs in veterans with diabetes mellitus but only in the most medically complex individuals. This demonstrates the importance of appropriate targeting and suggests that the effect of HBPC is attributable to its comprehensive approach rather than condition-specific interventions. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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