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In-home visits and subsequent health outcomes in Medicare Advantage beneficiaries with coronary artery disease, diabetes, hypertension, and depression
Smolderen, K., Heath, K., Ameli, O., Spencer, D. L., Natwick, T., Musich, S., & Mena-Hurtado, C. (2023). In-home visits and subsequent health outcomes in Medicare Advantage beneficiaries with coronary artery disease, diabetes, hypertension, and depression. Medical Care, 61(6), 336-376. https://doi.org/10.1097/MLR.0000000000001850
Background: Coronary artery disease, diabetes, hypertension, and depression are common burdensome conditions.
Objectives: To examine whether multidimensional preventive in-home visits were associated with fewer emergency and inpatient care episodes and higher quality of care.
Research Design: An observational, retrospective data analysis.
Subjects: A nationwide Medicare Advantage population from the Optum Labs Data Warehouse.
Measures: We compared beneficiaries with 1 or more of the conditions with an in-home visit in 2018 (“Exposure”) with those without a visit in 2018 but with a future visit in 2019 (“Wait List Control”) using a difference-in-differences analysis. Primary outcomes were 1-year all-cause inpatient care and emergency visit counts. Secondary outcomes included primary care visits, major adverse cardiovascular events, and select quality-of-care metrics. An exploratory outcome was the time-to-first primary care visit after the index date.
Results: Among those eligible to receive an in-home visit, a total of 48,566 patients had an in-home visit in 2018 (the “Exposure” group), and 36,549 beneficiaries constituted the “Wait List” control group. Receiving an in-home visit early was associated with a greater decrease in inpatient stays for all 4 conditions (change score range for any stay: −5.22% to −2.47%) (P<0.001, depression <0.05); decrease in emergency visits (change score range for any stay: −4.39% to −3.67%) (P<0.0.001, depression <0.05); and fewer major adverse cardiovascular events for coronary artery disease and depression (P<0.001 and <0.025, respectively) 1 year later. Minimal differences were noted for change in ambulatory and primary care visits, with no consistent increase in quality-of-care metrics. Time-to-first primary care visit was shorter for the “Exposure” versus the Wait List control group in all conditions (difference between 2.45 and 4.95 d).
Conclusions: The feasibility and impact of a nationwide multidimensional preventive in-home visit were demonstrated, targeting common and high morbidity conditions. Benefits were observed against a Wait List control group, resulting in less resource-intense care.
