Journal of the American Medical Directors Association · 2025
Utilization of Occupational and Physical Therapy Home Health Visits Among People Living With Dementia With Varying Social Determinants of Health.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Lassell Rebecca K F, Muruganand Ashwath, Gan Adeline, Fletcher Jason, Lin Shih-Yin, Brody Abraham A
Аннотация
OBJECTIVE: We sought to identify patterns in occupational therapy (OT) and physical therapy (PT) home health care visits among people living with dementia (PLWD) by (1) level of function care partner report compared with administrative data, (2) race and ethnicity, and (3) level of socioeconomic resources.
DESIGN: A secondary analysis.
SETTING AND PARTICIPANTS: We used data collected from 152 PLWD-care partner dyads enrolled in a hybrid type I effectiveness trial at a large, urban, Medicare-certified, nonprofit home health care agency in the northeastern United States.
METHODS: Function was measured with the Caregiver Quality of Life Assistance in Activities of Daily Living (ADLs) and Assistance in Instrumental Activities of Daily Living (IADLs) subscales. PLWD's addresses were used to measure socioeconomic deprivation using the Area Deprivation Index (ADI). The number of OT/PT visits were calculated for the first 30 days of enrollment in the study with care partners' reports and administrative data. Visit data were compared and analyzed using a Wilcoxon signed-rank test and a zero-inflated negative binomial regression. Differences in the number of OT/PT visits was compared across racial and ethnic groups, ADI quartiles, and level of function using regression and controlling for education and comorbidities.
RESULTS: Hispanic (mean: 1.4, SD: 0.754) and non-Hispanic Black (mean: 1.6, SD: 0.769) PLWD had significantly lower ADL function at baseline than White individuals (mean: 2.103, SD: 0.882) (P = .002) that increased over 30 days (P = .513). A significant difference existed between care partner and administrative reports in the number of PT visits (F = 0.97, P = .459) but not OT visits. There were no differences in OT/PT utilization based on race and ethnicity and socioeconomic resources.
CONCLUSIONS AND IMPLICATIONS: Caregiver report was not reliable for PT visits received in home health care. OT/PT home health care utilization may help reduce disparities in ADL function across racial and ethnic groups.
DESIGN: A secondary analysis.
SETTING AND PARTICIPANTS: We used data collected from 152 PLWD-care partner dyads enrolled in a hybrid type I effectiveness trial at a large, urban, Medicare-certified, nonprofit home health care agency in the northeastern United States.
METHODS: Function was measured with the Caregiver Quality of Life Assistance in Activities of Daily Living (ADLs) and Assistance in Instrumental Activities of Daily Living (IADLs) subscales. PLWD's addresses were used to measure socioeconomic deprivation using the Area Deprivation Index (ADI). The number of OT/PT visits were calculated for the first 30 days of enrollment in the study with care partners' reports and administrative data. Visit data were compared and analyzed using a Wilcoxon signed-rank test and a zero-inflated negative binomial regression. Differences in the number of OT/PT visits was compared across racial and ethnic groups, ADI quartiles, and level of function using regression and controlling for education and comorbidities.
RESULTS: Hispanic (mean: 1.4, SD: 0.754) and non-Hispanic Black (mean: 1.6, SD: 0.769) PLWD had significantly lower ADL function at baseline than White individuals (mean: 2.103, SD: 0.882) (P = .002) that increased over 30 days (P = .513). A significant difference existed between care partner and administrative reports in the number of PT visits (F = 0.97, P = .459) but not OT visits. There were no differences in OT/PT utilization based on race and ethnicity and socioeconomic resources.
CONCLUSIONS AND IMPLICATIONS: Caregiver report was not reliable for PT visits received in home health care. OT/PT home health care utilization may help reduce disparities in ADL function across racial and ethnic groups.