دورية أكاديمية
أعرض في EDS

Long-term outcomes after rehabilitation in Medicare Advantage and fee-for-service beneficiaries.

التفاصيل البيبلوغرافية
العنوان: Long-term outcomes after rehabilitation in Medicare Advantage and fee-for-service beneficiaries.
المؤلفون: Lam K; Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.; Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Kleijwegt H; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Bollens-Lund E; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Nicholas LH; Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.; Department of Economics, University of Colorado Denver, Denver, Colorado, USA., Covinsky KE; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA., Ankuda CK; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
المصدر: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Jun; Vol. 72 (6), pp. 1697-1706. Date of Electronic Publication: 2024 Apr 10.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Blackwell Science Country of Publication: United States NLM ID: 7503062 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-5415 (Electronic) Linking ISSN: 00028614 NLM ISO Abbreviation: J Am Geriatr Soc Subsets: MEDLINE
أسماء مطبوعة: Publication: Malden, MA : Blackwell Science
Original Publication: New York [etc.]
مواضيع طبية MeSH: Fee-for-Service Plans*/statistics & numerical data , Medicare Part C*/statistics & numerical data, Humans ; Female ; United States ; Male ; Aged ; Retrospective Studies ; Aged, 80 and over ; Physical Functional Performance
مستخلص: Background: Financial incentives in capitated Medicare Advantage (MA) plans may lead to inadequate rehabilitation. We therefore investigated if MA enrollees had worse long-term physical performance and functional outcomes after rehabilitation.
Methods: We conducted a retrospective cohort study of Medicare beneficiaries in the nationally representative National Health and Aging Trends Study. We compared MA and fee-for-service (FFS) beneficiaries reporting rehabilitation between 2014 and 2017 by change in (1) Short Physical Performance Battery (SPPB) and (2) NHATS-derived Functional Independence Measure (FIM) from the previous year, using t-tests incorporating inverse-probability weighting and complex survey design. Secondary outcomes were self-reported: (1) improved function during rehabilitation, (2) worse function since rehabilitation ended, (3) meeting rehabilitation goals, and (4) meeting insurance limits.
Results: Among 738 MA and 1488 FFS participants, weighted mean age was 76 years (SD 7.0), 59% were female, and 9% had probable dementia. MA beneficiaries were more likely to be Black (9% vs. 6%) or Hispanic/other race (15% vs. 10%), be on Medicaid (14% vs. 10%), have lower income (median $35,000 vs. $48,000), and receive <1 month of rehabilitation (30% vs. 23%). MA beneficiaries had a similar decline in SPPB (-0.46 [SD 1.8] vs. -0.21 [SD 2.7], p-value 0.069) and adapted FIM (-1.05 [SD 3.7] vs. -1.13 [SD 5.45], p-value 0.764) compared to FFS. MA beneficiaries were less likely to report improved function during rehabilitation (61% [95% CI 56-67] vs. 70% [95% CI 67-74], p-value 0.006). Other outcomes and analyses restricted to inpatient rehabilitation participants were non-significant.
Conclusions and Relevance: MA enrollment was associated with lower likelihood of self-reported functional improvement during rehabilitation but no clinically or statistically significant differences in annual changes of physical performance or function. As MA expands, future studies must monitor implications on rehabilitation coverage and older adults' independence.
(© 2024 The American Geriatrics Society.)
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معلومات مُعتمدة: K76 AG064427 United States AG NIA NIH HHS; P30 AG044281 United States AG NIA NIH HHS; R03 AG074038 United States AG NIA NIH HHS; R56 AG065369 United States AG NIA NIH HHS; K76 AG064427 United States AG NIA NIH HHS; P30 AG044281 United States AG NIA NIH HHS; R03 AG074038 United States AG NIA NIH HHS; R56 AG065369 United States AG NIA NIH HHS
فهرسة مساهمة: Keywords: Medicare Advantage; function; physical performance; rehabilitation
تواريخ الأحداث: Date Created: 20240410 Date Completed: 20240618 Latest Revision: 20240618
رمز التحديث: 20240619
DOI: 10.1111/jgs.18917
PMID: 38597342
قاعدة البيانات: MEDLINE
الوصف
تدمد:1532-5415
DOI:10.1111/jgs.18917