Impact of a home health care program for disabled patients in Taiwan: A nationwide population-based cohort study
Journal
Medicine (United States)
Journal Volume
98
Journal Issue
7
Pages
e14502
Date Issued
2019
Author(s)
Huang C.-T.
Kuo C.-S.
Chang Y.-K.
Hsu C.-C.
Abstract
The aim of this study was to evaluate the impact of home health care (HHC) for disabled patients.We conducted a nationwide population-based retrospective cohort study. A total of 5838 disabled patients with HHC were identified to match by propensity score with 15,829 disabled patients without HHC receiving tube or catheter care (tracheostomy tube, nasogastric tube, urinary catheter, cystostomy tube, nephrostomy tube) or stage 3 or 4 pressure sore care from the Taiwanese National Health Insurance Research Database between 2005 and 2009. After 1:1 matching, 2901 subjects in the HHC group and 2901 subjects in the non-HHC group were selected and analyzed. Generalized estimating equations (GEEs) were used to compare the risk of health outcomes (rate of hospitalization and emergency services use) and the healthcare expenditure between the 2 groups.Compared to those in the non-HHC group, the patients in the HHC group had significantly higher risk for hospitalization (odds ratio [OR]=18.43, 95% confidence interval [CI]: 15.62-21.75, P<.001) and emergency services use (OR=3.72, 95% CI: 3.32-4.17, P<.001) 1 year before the index date. However, 1 year after the index date, the risk for hospitalization (OR=1.6, 95% CI: 1.41-1.83, P<.001) and emergency services use (OR=1.16, 95% CI: 1.04-1.30, P<.05) attenuated significantly. Regarding the comparison of total healthcare expenditure 1 year before and after the index date, our study showed an insignificant decrease of US$1.5 per person per day and a significant increase of US$5.2 per person per day (P<.001) in the HHC and non-HHC groups, respectively.The HHC for disabled patients has a potential role to reduce hospitalization and emergency services use. Besides, the improvement of healthcare quality through HHC was not accompanied by increased healthcare expenditure. The clinical impact of HHC emphasizes the importance for public health officials to promote HHC model to meet the needs of disabled patients. Copyright ? 2019 the Author(s). Published by Wolters Kluwer Health, Inc.
SDGs
Other Subjects
aged; Article; cerebrovascular disease; cohort analysis; comparative study; controlled study; decubitus; dementia; diabetes mellitus; disabled person; female; health care cost; home care; hospital admission; human; hypertension; major clinical study; male; middle cerebral artery occlusion; priority journal; retrospective study; Taiwan; Taiwanese; treatment outcome; upper respiratory tract infection; adolescent; adult; child; economics; home care; hospital emergency service; hospitalization; infant; middle aged; newborn; preschool child; statistics and numerical data; time factor; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Disabled Persons; Emergency Service, Hospital; Female; Health Expenditures; Home Care Services; Hospitalization; Humans; Infant; Infant, Newborn; Male; Middle Aged; Retrospective Studies; Taiwan; Time Factors; Young Adult
Publisher
Lippincott Williams and Wilkins
Type
journal article