Beschreibung:
<jats:sec><jats:title>Objectives</jats:title><jats:p>To determine the effect of home‐based primary care (<jats:styled-content style="fixed-case">HBPC</jats:styled-content>) on Medicare costs and mortality in frail elders.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Case–control concurrent study using Medicare administrative data.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p><jats:styled-content style="fixed-case">HBPC</jats:styled-content> practice in Washington, District of Columbia.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p><jats:styled-content style="fixed-case">HBPC</jats:styled-content> cases (n = 722) and controls (n = 2,161) matched for sex, age bands, race, Medicare buy‐in status (whether Medicaid covers Part B premiums), long‐term nursing home status, cognitive impairment, and frailty. Cases were eligible if enrolled in MedStar Washington Hospital Center's <jats:styled-content style="fixed-case">HBPC</jats:styled-content> program during 2004 to 2008. Controls were selected from Washington, District of Columbia, and urban counties in Virginia, Maryland, and Pennsylvania.</jats:p></jats:sec><jats:sec><jats:title>Intervention</jats:title><jats:p><jats:styled-content style="fixed-case">HBPC</jats:styled-content> clinical service.</jats:p></jats:sec><jats:sec><jats:title>Measurements</jats:title><jats:p>Medicare costs, utilization events, mortality.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Mean age was 83.7 for cases and 82.0 for controls (<jats:italic>P</jats:italic> < .001). A majority of both groups was female (77%) and African American (90%). During a mean 2‐year follow‐up, in univariate analysis, cases had lower Medicare ($44,455 vs $50,977, <jats:italic>P</jats:italic> = .01), hospital ($17,805 vs $22,096, <jats:italic>P</jats:italic> = .003), and skilled nursing facility care ($4,821 vs $6,098, <jats:italic>P</jats:italic> = .001) costs, and higher home health ($6,579 vs $4,169; <jats:italic>P</jats:italic> < .001) and hospice ($3,144 vs. $1,505; <jats:italic>P</jats:italic> = .005) costs. Cases had 23% fewer subspecialist visits (<jats:italic>P</jats:italic> = .001) and 105% more generalist visits (<jats:italic>P</jats:italic> < .001). In a multivariate model, cases had 17% lower Medicare costs, averaging $8,477 less per beneficiary (<jats:italic>P</jats:italic> = .003) over 2 years of follow‐up. There was no difference between cases and controls in mortality (40% vs 36%, hazard ratio = 1.06, <jats:italic>P</jats:italic> = .44) or in average time to death (16.2 vs 16.8 months, <jats:italic>P</jats:italic> = .30).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p><jats:styled-content style="fixed-case">HBPC</jats:styled-content> reduces Medicare costs for ill elders, with similar survival outcomes in cases and controls.</jats:p></jats:sec>