Prevalence of Independence at Home-Qualifying Beneficiaries in Traditional Medicare, 2014-2021.

Importance: The Centers for Medicare & Medicaid Services Innovation Center Independence at Home (IAH) demonstration, a test of home-based primary care operating in a value-based shared-savings payment model, ended December 2023 after a decade of consistently showing savings to Medicare. It is important to assess whether high-need, IAH-qualified beneficiaries continue to pose a growing challenge to traditional Medicare (TM) or if Medicare Advantage (MA), with programmatic features favorable to caring for this subset of the general Medicare population, can disproportionately provide such care.

Objective: To examine the size and share of IAH-qualified beneficiaries in TM and MA.

Integrated Home- and Community-Based Services Improve Community Survival Among Independence at Home Medicare Beneficiaries Without Increasing Medicaid Costs.

Objectives: To determine the effect of home-based primary care (HBPC) for frail older adults, operating under Independence at Home (IAH) incentive alignment on long-term institutionalization (LTI).

Design: Case-cohort study using HBPC site, Medicare administrative data, and National Health and Aging Trends Study (NHATS) benchmarks.

Setting: Three IAH-participating HBPC sites in Philadelphia, PA, Richmond, VA, and Washington, DC.

Home-Based Primary Care: Beyond Extension of the Independence at Home Demonstration.

The Independence at Home (IAH) Demonstration Year 2 results confirmed that the first-year savings were 10 times as great as those of the pioneer accountable care organizations during their initial 2 years. We update projected savings from nationwide conversion of the IAH demonstration, incorporating Year 2 results and improving attribution of IAH-qualified (IAH-Q) Medicare beneficiaries to home-based primary care (HBPC) practices. Applying IAH qualifying criteria to beneficiaries in the Medicare 5% claims file, the effect of expanding HBPC to the 2.

Projected Savings and Workforce Transformation from Converting Independence at Home to a Medicare Benefit.

The Independence at Home (IAH) Demonstration Year 1 results have confirmed earlier studies that showed the ability of home-based primary care (HBPC) to improve care and lower costs for Medicare's frailest beneficiaries. The first-year report showed IAH savings of 7.7% for all programs and 17% for the nine of 17 programs that surpassed the 5% mandatory savings threshold.

Effects of home-based primary care on Medicare costs in high-risk elders.

Objectives: To determine the effect of home-based primary care (HBPC) on Medicare costs and mortality in frail elders.

Design: Case-control concurrent study using Medicare administrative data.

Setting: HBPC practice in Washington, District of Columbia.

Pneumonia in the long-term resident.

Pneumonia in the long-term resident is common. It is associated with high morbidity and mortality. However, diagnosis and management of pneumonia in long-term care residents is challenging.

Independence at home: community-based care for older adults with severe chronic illness.

By most clinical and economic measures, our health care system is not providing effective or affordable care to Medicare beneficiaries with severe chronic illness. Two million elders, constituting most of the 5% who account for nearly half of Medicare costs, have multiple chronic conditions, functional disability, and average per capita costs of over $50,000 per year. Prior reforms aimed at this population did not change the flawed delivery system, which remains centered in the doctor's office, hospitals, and nursing homes.

Nursing home characteristics related to medicare costs for residents with and without dementia.

Objectives: To evaluate the relationship of nursing home characteristics to Medicare costs overall and by dementia status.

Design: New admissions followed for 2 years. Setting.

National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system.

The National Pressure Ulcer Advisory Panel has updated the definition of a pressure ulcer and the stages of pressure ulcers based on current research and expert opinion solicited from hundreds of clinicians, educators, and researchers across the country. The amount of anatomical tissue loss described with each stage has not changed. New definitions were drafted to achieve accuracy, clarity, succinctness, clinical utility, and discrimination between and among the definitions of other pressure ulcer stages and other types of wounds.

National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system.

The National Pressure Ulcer Advisory Panel has updated the definition of a pressure ulcer and the stages of pressure ulcers based on current research and expert opinion solicited from hundreds of clinicians, educators, and researchers across the country. The amount of anatomical tissue loss described with each stage has not changed. New definitions were drafted to achieve accuracy, clarity, succinctness, clinical utility, and discrimination between and among the definitions of other pressure ulcer stages and other types of wounds.

Mortality and adverse health events in newly admitted nursing home residents with and without dementia.

Objectives: To evaluate the association between dementia and mortality, adverse health events, and discharge disposition of newly admitted nursing home residents. It was hypothesized that residents with dementia would die at a higher rate and develop more adverse health events (e.g.

The National Pressure Ulcer Long-Term Care Study: outcomes of pressure ulcer treatments in long-term care.

Objectives: To identify resident, wound, and treatment characteristics associated with pressure ulcer (PrU) healing in long-term care residents.

Design: Retrospective cohort study with convenience sampling.

Setting: Ninety-five long-term care facilities participating in the National Pressure Ulcer Long-Term Care Study throughout the United States.

The National Pressure Ulcer Long-Term Care Study: pressure ulcer development in long-term care residents.

Objectives: To identify resident, treatment, and facility characteristics associated with pressure ulcer (PU) development in long-term care residents.

Design: Retrospective cohort study with convenience sampling.

Setting: Ninety-five long-term care facilities participating in the National Pressure Ulcer Long-Term Care Study throughout the United States.

Dementia as a risk factor for falls and fall injuries among nursing home residents.

Objectives: To compare rates of falling between nursing home residents with and without dementia and to examine dementia as an independent risk factor for falls and fall injuries.

Design: Prospective cohort study with 2 years of follow-up.

Setting: Fifty-nine randomly selected nursing homes in Maryland, stratified by geographic region and facility size.

Is there a doctor in the house?

The Washington Hospital Center initiated a geriatric medical and house call service for its local elderly population. Preliminary data shows that ER visits have been reduced by about 30 percent and admissions reduced by 10 percent, compared to the same patients in the year before enrollment. In most cases, the medical care is more effective, less costly, and more accessible for both the family and the health care system.

Agitation and depression in frail nursing home elderly patients with dementia: treatment characteristics and service use.

Objective: The authors describe characteristics, treatment, and acute service use associated with agitation and depression in dementia.

Methods: Authors used retrospective chart review of symptoms, physician-level prescribing, and acute service use over 3 months for 2,487 physically frail older residents, including 1,836 with dementia, (mean age: 79.8 years) in 109 long-term care facilities, describing differences between uncomplicated dementia and three mutually exclusive subgroups of complicated dementia, including dementia with agitation-only, dementia with depression-only, and dementia with mixed agitation and depression.

Description of the National Pressure Ulcer Long-Term Care Study.

Objectives: To describe and provide baseline data from The National Pressure Ulcer Long-Term Care Study (NPULS).

Design: Retrospective cohort study of detailed resident characteristics, treatments, and outcomes using convenience sampling.

Setting: One hundred nine long-term care facilities throughout the United States.