Posthospitalization Home Health Care Use and Changes in Functional Status in a Medicare Population

OBJECTIVE: The objective of this work was to estimate the effect of Medicare beneficiaries' use of home health care (HHC) for 6 months after hospital discharge on the change in functional status over a 1-year period beginning before hospitalization. DATA SOURCES AND STUDY SETTING: Data came from the Medicare Current Beneficiary Survey, which is a nationally representative sample of Medicare beneficiaries, in-person interview data, and Medicare claims for 1991 through 1994 for 2,127 nondisabled, community-dwelling, elderly Medicare beneficiaries who were hospitalized within 6 months of their annual in-person interviews. STUDY DESIGN: Econometric estimation with the instrumental variable method was used to correct for observational data bias, ie, the nonrandom allocation of discharged beneficiaries to the use of posthospitalization HHC. The analysis estimates a first-stage model of HHC use from which an instrumental variable estimate is constructed to estimate the effect on change in functional status. PRINCIPAL FINDINGS: The instrumental variable estimates suggest that HHC users experienced greater improvements in functional status than nonusers as measured by the change in a continuous scale based on the number and mix of activities of daily living and instrumental activities of daily living before and after hospitalization. The estimated improvement in functional status could be as large as 13% for a 10% increase in HHC use. In contrast, estimation with the observational data on HHC use implies that HHC users had poorer health outcomes. CONCLUSIONS: Adjusting for potential observational data bias is critical to obtaining estimates of the relationship between the use of posthospitalization HHC and the change in health before and after hospitalization. After adjustment, the results suggest that efforts to constrain Medicare's spending for HHC, as required by the Balanced Budget Act of 1997, may lead to poorer health outcomes for some beneficiaries

Activities of daily living · Beneficiary · Estimation · Health care · Instrumental variable · Long-term care · Observational study · Physical therapy · Selection bias · Statistics · Demography · Geriatric Care and Nursing Homes · Health disparities and outcomes · Heart Failure Treatment and Management · Medicine · Gerontology

• La hospitalización domiciliaria

  Open Access•Rosângela Minardi Mitre Cotta, María Morales Suárez-Varela et al.•Revista Panamericana de Salud…•2001

  Incluir item

• La hospitalización domiciliaria ante los cambios demográficos y nuevos retos de salud

  Open Access•Rosângela Minardi Mitre Cotta, María Morales Suárez-Varela et al.•Revista Panamericana de Salud…•2002

  Incluir item

• Effective Coordination of Medical and Supportive Services

  Open Access•John A Capitman, John Capitman•Journal of Aging and Health•2003

  Incluir item

• Choice of Personal Assistance Services Providers by Medicare Beneficiaries Using a Consumer-Directed Benefit

  Open Access•Hongdao Meng, Bruce Friedman et al.•The Journal of Rural Health•2010

  Incluir item

• Physicians??? Responses to Medicare Fee Schedule Reductions

  Jean M Mitchell, Jack Hadley et al.•Medical Care•2000

  Incluir item

• Measuring Disability in Medicare Home Care Patients

  Richard H Fortinsky, Ramon I Garcia et al.•Medical Care•2003

  Incluir item

• Marriage, widowhood, and health-care use

  Open Access•Theodore J Iwashyna, Nicholas A Christakis•Social Science & Medicine•2003

  Incluir item

• Elements of Econometrics

  Jan Kmenta•Elements of econometrics•1997

  Incluir item

• Problems with Instrumental Variables Estimation When the Correlation Between the Instruments and the Endogeneous Explanatory Variable is Weak

  John Bound, David A Jaeger et al.•Journal of the American…•1995

  Incluir item

• Does More Intensive Treatment of Acute Myocardial Infarction in the Elderly Reduce Mortality?

  Mark Mcclellan•JAMA•1994

  Incluir item

• Problems with Instrumental Variables Estimation when the Correlation between the Instruments and the Endogenous Explanatory Variable is Weak

  John Bound, David A Jaeger et al.•Journal of the American…•1995

  Incluir item

• Instrumental Variables Regression with Weak Instruments

  Douglas O Staiger, Douglas Staiger et al.•Econometrica•1997

  Incluir item

• Is access to home health care a problem in rural areas

  G M Kenney, G Kenney•American Journal of Public Health•1993

  Incluir item

• Understanding the State Variation in Medicare Home Health Care

  Marc Cohen, Marc A Cohen et al.•Medical Care•1997

  Incluir item

• Explaining Area Variation in the Use of Medicare Home Health Services

  Genevieve M Kennedy, Genevieve Kennedy et al.•Medical Care•1992

  Incluir item

• Comparison of Services Among Different Types of Home Health Agencies

  Brent Williams, Brent C Williams•Medical Care•1994

  Incluir item