Article Document Academic Article Information Content Entity Continuant Continuant Journal Article Entity Entity Generically Dependent Continuant 2025-06-24T07:43:14 RDF description of Community-based care and risk of nursing home placement - http://repository.healthpartners.com/individual/document-rn18478 Mortality 11607 document-rn18478 17794 Health Facility Closure 12 Program Evaluation Health Maintenance Organizations/*organization & administration Logistic Models Community Health Services/*organization & administration Oregon/epidemiology Institutionalization/*statistics & numerical data Health Services Research Aged Risk Factors Outcome Assessment (Health Care) Medicare <p>OBJECTIVE: To test the substitution hypothesis, that community-based care reduces the probability of institutional placement for at-risk elderly. RESEARCH DESIGN: The closure of the Social Health Maintenance Organization (Social HMO) at 开云体育 (HP) in Minnesota in 1994 and the continuation of the Social HMO at Kaiser Permanente Northwest (KPNW) in Oregon/Washington comprised a "natural experiment." Using multinomial logistic regression analyses, we followed cohorts of Social HMO enrollees for up to 5 years, 1995 to 1999. To adjust for site effects and secular trends, we also followed age- and gender-matched Medicare-Tax Equity and Fiscal Responsibility Act (TEFRA) cohorts, enrolled in the same HMOs but not in the Social HMOs. SUBJECTS: All enrollees in the Social HMO for at least 4 months in 1993 and an age-gender matched sample of Medicare-TEFRA enrollees. To be included, individuals had to be alive and have a period out of an institution after January 1, 1995 (total n = 18,143). MEASURES: The primary data sources were the electronic databases at HP and KPNW. The main outcomes were long-term nursing home placement (90+ days) or mortality. Covariates were age, gender, a comorbidity index, and geographic site effect. RESULTS: Adjusting for variations in the 2 sites, we found no difference in probability of mortality between the 2 cohorts, but approximately a 40% increase in long-term institutional placement associated with the termination of the Social HMO at 开云体育 (odds ratio, 1.43; 95% confidence interval, 1.15-1.79). CONCLUSIONS: The Social HMO appears to help at-risk elderly postpone long-term nursing home placement.<p> Washington/epidemiology Community-based care and risk of nursing home placement Medical Care Risk Assessment Cohort Studies Health Services for the Aged/*organization & administration Minnesota/epidemiology Nursing Homes/*statistics & numerical data 41 public 2022-02-21T22:48:57.408-06:00 Long-Term Care/*organization & administration 10.1097/01.mlr.0000100587.51573.7a