Effects of post-hospital Medicare home health and informal care on patient functional status.
OBJECTIVE
To examine the effect of post-hospital Medicare home health and informal care on the functional status of 755 Medicare beneficiaries six weeks after hospital discharge for treatment of stroke, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hip procedures, and hip fractures.


METHODS
Consecutive patients enrolled in the study between March 1988 and February 1989 prior to discharge from one of 52 hospitals in three cities. Data sources included patient interviews, medical records, and the Medicare Automated Data Retrieval System (MADRS).


METHODS
The effect of the two types of care on patients' subsequent functional status was estimated using a selectivity corrected least squares regression of functional status six weeks post-discharge on hours of informal care, Medicare home health expenditures, and patient prior functional and cognitive status.


METHODS
Patients were interviewed before hospital discharge and six weeks later. The patient's primary caregiver was interviewed by telephone six weeks post-discharge. Patient data included demographic characteristics, illness severity, cognitive status, functional status at discharge and six weeks later, post-discharge expenditures for Medicare home health, and hours of informal care.


RESULTS
More informal care after discharge was associated with greater patient functional impairment six weeks later. The amount of Medicare home health that patients used had a nonsignificant effect on subsequent functional status.


CONCLUSIONS
Post-acute home care may maintain the patient at home and compensate for functional limitations, rather than promote restoration of function. Future studies are needed to examine the effects of specific types of care, services, and providers as well as factors that mediate their effects on patient functional outcomes.
Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha 68198-4350, USA.
J D
JD
Penrod
R L
RL
Kane
M D
MD
Finch
R A
RA
Kane
D000203:Activities of Daily Living; D000359:Aftercare / Q000191:economics / Q000706:statistics & numerical data*; D000368:Aged; D017028:Caregivers / Q000706:statistics & numerical data; D003071:Cognition; D003625:Data Collection; D003710:Demography; D005260:Female; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States