Association Between Home-Base Primary Care and Postdischarge Outcomes Among Older Adults in Korea

Hyun Ji Lee; Ae Jung Yoo; Hyo Jung Bang; Hyun-Kyung Park; Jae Woo Choi

doi:10.1016/j.jamda.2024.105415

Association Between Home-Base Primary Care and Postdischarge Outcomes Among Older Adults in Korea

J Am Med Dir Assoc. 2024 Dec 26;26(2):105415. doi: 10.1016/j.jamda.2024.105415. Online ahead of print.

Authors

Hyun Ji Lee¹, Ae Jung Yoo², Hyo Jung Bang², Hyun-Kyung Park², Jae Woo Choi³

Affiliations

¹ Health Insurance Research Institute, National Health Insurance Service, Wonju-si, Gangwon-do, South Korea; Division of Healthcare Administration, Yonsei University, Wonju-si, Gangwon-do, South Korea.
² Health Insurance Research Institute, National Health Insurance Service, Wonju-si, Gangwon-do, South Korea.
³ Health Insurance Research Institute, National Health Insurance Service, Wonju-si, Gangwon-do, South Korea; Division of Healthcare Administration, Yonsei University, Wonju-si, Gangwon-do, South Korea. Electronic address: jwchoi2695@hanmail.net.

PMID: 39689865
DOI: 10.1016/j.jamda.2024.105415

Abstract

Objectives: This study aimed to evaluate the association between home-based primary care (HBPC) and postdischarge outcomes in Korean older adults.

Design: HBPC was a service that provided medical care by visiting the homes of older adults with limited mobility. In this study, data from the National Health Insurance Service (NHIS) were used, and groups with and without HBPC services were matched 1:1 through propensity score matching. Cox proportional hazards model and linear regression analysis were performed to compare the HBPC group with the control group.

Setting and participants: Overall, 1580 older adults in Korea who used HBPC services after discharge from hospital and 1580 propensity score-matched older adults who did not use HBPC services were included.

Methods: For 30-day readmission, hospitalizations, and admission to long-term care hospitals or facilities after discharge, this study used a Cox proportional hazards regression model. And linear regression analysis was performed considering that the dependent variable was a continuous variable to examine the average total medical costs after discharge from acute hospital.

Results: Older adults who used HBPC services exhibited a lower risk of readmission for the same disease (risk reduction of 0.66, 95% CI 0.50, 0.87) and hospitalization (risk reduction of 0.58, 95% CI 0.46, 0.73) compared with those who did not use HBPC services. The annual average total medical cost was $4764 lower for older adults who used HBPC services than for those who did not (95% CI -6469.49, -3057.52). There was no significant difference in the risk of admission to long-term care hospitals or facilities.

Conclusions and implications: HBPC services had a positive effect on reducing 30-day readmission due to the same disease, hospitalization, and annual average total medical costs among older adults after discharge.

Keywords: Integrated care; home-based primary care; older adults.