Journal of the American Medical Directors Association · 2026
Home Health Pathways Relevant to Patient-Driven Groupings Model Classification Among Medicare Beneficiaries With and Without Dementia.
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Knox Sara, Johnson Jada, Dooley Mary, Cutty Maxwell, Maldonado Lizmarie, Ward Ralph, Simpson Kit N
Аннотация
OBJECTIVES: To characterize admission-source and episode timing pathways among Medicare Home Health (HH) beneficiaries with and without Alzheimer's disease and related dementias (ADRD) immediately prior to the Patient-Driven Groupings Model (PDGM) implementation, which incorporated these factors into HH payment.
DESIGN: Retrospective secondary analysis of national Medicare claims data from 2019, with propensity score matching of beneficiaries classified as ADRD highly likely and ADRD unlikely.
SETTING AND PARTICIPANTS: A total of 129,429 ADRD-highly likely HH beneficiaries were matched 1:1 to 129,429 ADRD-unlikely HH beneficiaries.
METHODS: Outcomes included annual counts of community and institutional HH admissions and late HH episodes, as well as Health Insurance Prospective Payment System 1 classifications reflecting admission source and episode timing. Incidence rate ratios (IRRs) and odds ratios were estimated to compare HH utilization and classification patterns between matched groups.
RESULTS: The matched cohort included 129,429 beneficiary pairs. Compared with ADRD-unlikely beneficiaries, ADRD-highly likely beneficiaries had more community admissions (mean, 2.7 vs 2.4; IRR, 2.75; 95% CI, 2.73-2.76) and more late episodes (mean, 2.35 vs 2.05; IRR, 2.35; 95% CI, 2.34-2.37). ADRD status was not associated with the likelihood of any institutional admission (odds ratio, 1.00; 95% CI, 0.98-1.01). Among beneficiaries with at least 1 institutional admission, ADRD-highly likely beneficiaries had higher institutional admission rates (IRR, 1.12; 95% CI, 1.09-1.14). ADRD-highly likely beneficiaries also had higher odds of community early and community late classifications relative to institutional early episodes.
CONCLUSIONS AND IMPLICATIONS: Immediately before PDGM implementation, ADRD-highly likely beneficiaries were more likely to enter HH from the community and to experience later episodes of care. These findings establish a pre-PDGM benchmark for understanding how beneficiaries with ADRD were distributed across admission source and episode-timing pathways subsequently incorporated into HH payment. Future research should evaluate whether PDGM has differentially affected HH access, utilization, payment, and care delivery for beneficiaries with ADRD.
DESIGN: Retrospective secondary analysis of national Medicare claims data from 2019, with propensity score matching of beneficiaries classified as ADRD highly likely and ADRD unlikely.
SETTING AND PARTICIPANTS: A total of 129,429 ADRD-highly likely HH beneficiaries were matched 1:1 to 129,429 ADRD-unlikely HH beneficiaries.
METHODS: Outcomes included annual counts of community and institutional HH admissions and late HH episodes, as well as Health Insurance Prospective Payment System 1 classifications reflecting admission source and episode timing. Incidence rate ratios (IRRs) and odds ratios were estimated to compare HH utilization and classification patterns between matched groups.
RESULTS: The matched cohort included 129,429 beneficiary pairs. Compared with ADRD-unlikely beneficiaries, ADRD-highly likely beneficiaries had more community admissions (mean, 2.7 vs 2.4; IRR, 2.75; 95% CI, 2.73-2.76) and more late episodes (mean, 2.35 vs 2.05; IRR, 2.35; 95% CI, 2.34-2.37). ADRD status was not associated with the likelihood of any institutional admission (odds ratio, 1.00; 95% CI, 0.98-1.01). Among beneficiaries with at least 1 institutional admission, ADRD-highly likely beneficiaries had higher institutional admission rates (IRR, 1.12; 95% CI, 1.09-1.14). ADRD-highly likely beneficiaries also had higher odds of community early and community late classifications relative to institutional early episodes.
CONCLUSIONS AND IMPLICATIONS: Immediately before PDGM implementation, ADRD-highly likely beneficiaries were more likely to enter HH from the community and to experience later episodes of care. These findings establish a pre-PDGM benchmark for understanding how beneficiaries with ADRD were distributed across admission source and episode-timing pathways subsequently incorporated into HH payment. Future research should evaluate whether PDGM has differentially affected HH access, utilization, payment, and care delivery for beneficiaries with ADRD.