Continuity of care and health care cost among community-dwelling older adult veterans living with dementia.
Aged
Aged, 80 and over
Continuity of Patient Care
/ economics
Dementia
/ economics
Emergency Service, Hospital
/ economics
Female
Health Expenditures
/ statistics & numerical data
Health Services
/ economics
Homes for the Aged
/ economics
Humans
Independent Living
Male
Medicare
/ economics
Nursing Homes
/ economics
United States
Veterans
VA health care system
aging/elderly/geriatrics
dementia
health care cost
instrumental variables
primary care
Journal
Health services research
ISSN: 1475-6773
Titre abrégé: Health Serv Res
Pays: United States
ID NLM: 0053006
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
pubmed:
20
8
2020
medline:
15
12
2021
entrez:
20
8
2020
Statut:
ppublish
Résumé
To estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community-dwelling older veterans with dementia. Combined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014-2015. FY 2014 COC was measured by the Bice-Boxerman Continuity of Care (BBC) index on a 0-1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long-/short-stay nursing home, and noninstitutional long-term care (LTC) cost for medical (like skilled-) and social (like unskilled-) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders. Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N = 102 073). Mean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35 425. A 0.1 higher BBC resulted in (a) $4045 lower total cost; (b) $1597 lower acute inpatient cost, $119 lower ED cost, $4368 lower long-stay nursing home cost; (c) $402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short-stay nursing home cost. COC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.
Identifiants
pubmed: 32812658
doi: 10.1111/1475-6773.13541
pmc: PMC8143692
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
378-388Informations de copyright
© Health Research and Educational Trust.
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