Healthcare Utilization and Outcomes among Home-care Patients in Different Care Settings

• Main Authors: Pei-Hsuan Hsu, 許珮萱
• Other Authors: Ming-Chin Yang
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/k7n2wr

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 107 === Background: Home care is an essential part of the long-term care system, and it also plays an important role in the medical system in an aging society. An aging society may cause changes in population and family structure, and increase the demand for care in the hospital and community. Patients may choose to receive care at home, nursing home or residential care home. This study aims to explore the expenditure and outcome of care delivered at different sites. Method: This study is a secondary data analysis of retrospective cohort studies. We used data for the year of 2010 from the National Health Insurance Research Database and collected data from patients receiving home care service in 2012. In this study, data from1,556 patients was collected and the patients were categorized into 3 groups: patients receiving care at home (HC), at nursing home (NH) and at residential care homes (RCH). Two-part model was used in this study. The first-stage multiple logistic regression analysis and second-stage generalized linear model analysis were conducted to verify the patients’ usages of outpatient department, emergency department, hospitalization, home care, and physician visits within one year after receiving home care, and make comparison between medical utilization and avoidable hospitalization. Results: Concerning medical utilization, in terms of (1) out-patient departments: patients utilizing nursing homes and residential care homes led to more outpatient visits than those utilizing home care by 44% and 13% (p<.001); and the outpatient expenses were higher among patients at nursing homes (14%, p<.01), and lower among patients at residential care homes (14%, p<.001) than among patients at home. (2) emergency room: patients utilizing nursing homes and residential care homes led to less emergency utilization than patients utilizing home care by 0.72 times (p<.05) and 0.63 times (p<.001); emergency visit: patients utilizing nursing homes and residential care homes led to less emergency visits than patients utilizing home care by 0.35 times and 0.43 times (p<.001) ; and the difference in emergency department expenses among different sites was not significant. (3) hospitalization: the difference in admission at different sites was not significant; patients utilizing nursing homes and residential care homes made fewer days of stay than those utilizing home care by 14% and 24% (p<.001); patients utilizing nursing homes and residential care homes made fewer expense than those utilizing home care by 17% (p<.05). (4) home care: patients utilizing nursing homes and residential care homes utilized more home care services than those utilizing home care by 5% (p<.05); patents utilizing residential care homes got more expense of home care services than those utilizing home care by 12% (p<.01). (5) utilization of physician visit: patients utilizing nursing homes and residential care homes made more utilization of physician visits than those utilizing home care by 1.95 times and 1.99 times (p<.01); physician visit: patients utilizing nursing homes and residential care homes made more physician visits than those utilizing home care by 28% and 21% (p<.01); and the expense for patients utilizing nursing home was higher than those utilizing home care by 17% (p<.001). Concerning care outcomes, no significant difference was found in visits of avoidable hospitalization; patients utilizing nursing homes and residential care homes made fewer days of avoidable hospitalization than those utilizing home care by 29% and 32% (p<.001); patients utilizing nursing homes and residential care homes made fewer expense of avoidable hospitalization than those utilizing home care by 35% and 33% (p<.001). While the total expense of home care services is lower for patients receiving home care at home, the total expense of medical use for them is much higher than those who received their home care service in residential care homes. Conclusions: Overall, among home care recipients, those who received home care at home made more emergency visits; but those who received home care at nursing home made most outpatient visits, outpatient expenses, home care utilization and physician visits, followed by those who received home care at residential care homes. Parameters of residential care homes are usually between nursing homes and homes, except patients utilizing residential care homes made least emergency visits. There was no difference among hospitalization visits among the three groups, but those who received home care at home made most days of stay and emergency department expenses. Concerning the care outcome, those who received home care at home made most days of stay and expenses of avoidable hospitalization, which is mainly caused by infection in urinary tract, bacterial pneumonia, and chronic obstructive pulmonary disease. It is obvious that nursing needs of the patients receiving home care at home cannot be satisfied owing to the lack of regular nursing staff, which demands more emergency use. The outcome demonstrated that patients utilizing nursing home made more outpatient and home care utilization but less emergency use. Despite the outcome may indicate decent collaborations among institutes and hospitals, further examination may still be needed to verify if there are adequate home care applied in institutes.