Performance Improvement 2008. What Are the Care Pathways for Individuals Hospitalized with Congestive Heart Failure and Individuals Entering Nursing Homes?


This longitudinal study examined patterns of long term care of elderly beneficiaries with likely long-term care needs; the progress of groups of beneficiaries with similar health/functional status who remained in the community or who moved from the community to institutional settings; and the progress of those already within institutional settings. The study assessed the progress of beneficiaries with similar medical conditions, functional status, and long-term care needs through the health-care delivery system. It examined how insurance coverage, types of services used, processes leading to institutionalization, and costs of care, influenced the care provided.

The project obtained and constructed analytic files for two population cohorts for longitudinal analysis. The first consisted of elderly experiencing their first hospitalization for congestive heart failure (CHF) and used several years´ worth of Medicare enrollment data, all available Medicare Parts A and B claims data, nursing home patient assessment records, and area-level files. The second, using Medicare and Medicaid data consisted of elderly Medicare beneficiaries newly admitted to a nursing home in Minnesota and New Jersey (from either the community or continuing on after a Medicare-covered skilled stay).

For the CHF cohort, survival rates showed greater decline over time for older persons and persons with multiple co-morbidities. Older persons and persons with multiple co-morbidities had a shorter time to CHF re-hospitalization. Persons with multiple co-morbidities had higher total Medicare spending. Time to nursing home entry was shorter for older CHF patients. For the nursing home entrant cohort, about 43 percent survived after 36 months in each state. Fifty percent of the cohort members entered Medicaid within 36 months. Hospitalization rates and Medicare Part A spending were substantially higher in New Jersey than in Minnesota. High levels of co-morbidities increased mortality risk and hospitalization risk. Persons with lower cognitive status were more likely to enroll in Medicaid and have higher Medicaid expenditures.

Report Title: Examining Long-Term Care Episodes and Case History for Medicare Beneficiaries,
Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: William J. (Bill) Buczko, 410-786-6593
Performer: Urban Institute

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